Provider Demographics
NPI:1598898348
Name:PEET, ERIC KEES (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KEES
Last Name:PEET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 489
Mailing Address - Street 2:3413 ELIZABETH ST
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453
Mailing Address - Country:US
Mailing Address - Phone:269-857-5105
Mailing Address - Fax:269-857-5213
Practice Address - Street 1:3413 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-9736
Practice Address - Country:US
Practice Address - Phone:269-857-5105
Practice Address - Fax:269-857-5213
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEP006039111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383743771OtherSOIAL SECURITY
U45037Medicare UPIN
MIOG05171Medicare ID - Type UnspecifiedMEDICARE