Provider Demographics
NPI:1629149968
Name:PETERS WELLNESS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PETERS WELLNESS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-935-0911
Mailing Address - Street 1:1616 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1252
Mailing Address - Country:US
Mailing Address - Phone:623-935-0911
Mailing Address - Fax:623-935-0921
Practice Address - Street 1:1616 N LITCHFIELD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1252
Practice Address - Country:US
Practice Address - Phone:623-935-0911
Practice Address - Fax:623-935-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7767111NN1001X
CADC-29747111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty