Provider Demographics
NPI:1831291889
Name:DAWSON, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 BENSON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1669
Mailing Address - Country:US
Mailing Address - Phone:909-608-0190
Mailing Address - Fax:909-608-0194
Practice Address - Street 1:8900 BENSON AVE STE E
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1669
Practice Address - Country:US
Practice Address - Phone:909-608-0190
Practice Address - Fax:909-608-0194
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26704111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23594ZMedicare UPIN