Provider Demographics
NPI:1629148143
Name:COHEN, PETER ANSON (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANSON
Last Name:COHEN
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 1:1903 W 8TH ST
Mailing Address - Street 2:# 299
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4936
Mailing Address - Country:US
Mailing Address - Phone:814-454-4228
Mailing Address - Fax:814-452-4031
Practice Address - Street 1:2117 W. 8TH ST.
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-454-4228
Practice Address - Fax:814-452-4031
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005748L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA519947Medicare ID - Type Unspecified