Provider Demographics
NPI:1821125741
Name:PETER R SUTTON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PETER R SUTTON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-802-0797
Mailing Address - Street 1:4960 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5546
Mailing Address - Country:US
Mailing Address - Phone:480-802-0797
Mailing Address - Fax:480-895-3756
Practice Address - Street 1:4960 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 17
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5546
Practice Address - Country:US
Practice Address - Phone:480-802-0797
Practice Address - Fax:480-895-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83120Medicare PIN