Provider Demographics
NPI:1659523025
Name:PETER, JODIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:ANN
Last Name:PETER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ANN
Other - Last Name:KIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:330 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1612
Mailing Address - Country:US
Mailing Address - Phone:724-763-1238
Mailing Address - Fax:724-763-1058
Practice Address - Street 1:330 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1612
Practice Address - Country:US
Practice Address - Phone:724-763-1238
Practice Address - Fax:724-763-1058
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA378913YBJZMedicare PIN