Provider Demographics
NPI:1821538695
Name:PETERS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:PETERS CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-465-9173
Mailing Address - Street 1:18351 BEACH BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1347
Mailing Address - Country:US
Mailing Address - Phone:714-465-9173
Mailing Address - Fax:714-908-8028
Practice Address - Street 1:18351 BEACH BLVD STE H
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1347
Practice Address - Country:US
Practice Address - Phone:714-465-9173
Practice Address - Fax:714-908-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32342111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty