Provider Demographics
NPI:1942249297
Name:PAINTER, JOHN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:PAINTER
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 1:1701 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6859
Mailing Address - Country:US
Mailing Address - Phone:954-942-8402
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6859
Practice Address - Country:US
Practice Address - Phone:954-942-8402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6650111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician