Provider Demographics
NPI:1639247687
Name:PETERS, DONALD LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:PETERS
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 1:2 S MAYES ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-3232
Mailing Address - Country:US
Mailing Address - Phone:918-825-1151
Mailing Address - Fax:918-825-1102
Practice Address - Street 1:2 S MAYES ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-3232
Practice Address - Country:US
Practice Address - Phone:918-825-1151
Practice Address - Fax:918-825-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3741111N00000X
CA19944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor