Provider Demographics
NPI:1730287756
Name:PEETERS, KRISTEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:PEETERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5129
Mailing Address - Country:US
Mailing Address - Phone:315-339-3304
Mailing Address - Fax:315-339-3305
Practice Address - Street 1:110 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5129
Practice Address - Country:US
Practice Address - Phone:315-339-3304
Practice Address - Fax:315-339-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010980-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor