Provider Demographics
NPI:1720185176
Name:GEORGIOU, PETER (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GEORGIOU
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:GEORGIOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, CCSP
Mailing Address - Street 1:916 W. BELMONT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-665-4400
Mailing Address - Fax:773-665-4439
Practice Address - Street 1:916 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4427
Practice Address - Country:US
Practice Address - Phone:773-665-4400
Practice Address - Fax:773-665-4439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007148111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1682495OtherBLUE CROSS BLUE SHIELD
IL1682495OtherBLUE CROSS BLUE SHIELD