Provider Demographics
NPI:1861865735
Name:PETERS, JACE ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACE
Middle Name:ALAN
Last Name:PETERS
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 1:4909 CASS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2912
Mailing Address - Country:US
Mailing Address - Phone:712-520-2311
Mailing Address - Fax:
Practice Address - Street 1:15615 PACIFIC ST
Practice Address - Street 2:SUITE #106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2118
Practice Address - Country:US
Practice Address - Phone:403-933-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor