Provider Demographics
NPI:1740578285
Name:PETERS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PETERS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-285-6418
Mailing Address - Street 1:1704 S BOULEVARD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-285-6418
Mailing Address - Fax:405-385-6419
Practice Address - Street 1:1704 S BOULEVARD
Practice Address - Street 2:SUITE B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-285-6418
Practice Address - Fax:405-385-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty