Provider Demographics
NPI:1760481261
Name:ANNYSCHYN, PETER SANTO (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SANTO
Last Name:ANNYSCHYN
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 1:15123 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-3030
Mailing Address - Country:US
Mailing Address - Phone:313-886-1111
Mailing Address - Fax:313-886-0223
Practice Address - Street 1:15123 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3030
Practice Address - Country:US
Practice Address - Phone:313-886-1111
Practice Address - Fax:313-886-0223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005955111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician