Provider Demographics
NPI:1649241332
Name:PETERMANN, ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:PETERMANN
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 1:3714 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5157
Mailing Address - Country:US
Mailing Address - Phone:602-224-0004
Mailing Address - Fax:602-224-1182
Practice Address - Street 1:3714 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5157
Practice Address - Country:US
Practice Address - Phone:602-224-0004
Practice Address - Fax:602-224-1182
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT88247Medicare UPIN
AZT88247Medicare ID - Type Unspecified