Provider Demographics
NPI:1710138292
Name:PETERS, JAMES (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
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:W344 HIGHWAY DW
Mailing Address - Street 2:
Mailing Address - City:THERESA
Mailing Address - State:WI
Mailing Address - Zip Code:53091-9777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W344 HIGHWAY DW
Practice Address - Street 2:
Practice Address - City:THERESA
Practice Address - State:WI
Practice Address - Zip Code:53091-9777
Practice Address - Country:US
Practice Address - Phone:262-623-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4445-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor