Provider Demographics
NPI:1972700599
Name:EGAN, PETER ANTHONY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:EGAN
Suffix:JR
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 1:626 PICKETTS RDG
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7711
Mailing Address - Country:US
Mailing Address - Phone:770-529-1218
Mailing Address - Fax:
Practice Address - Street 1:619 EDGEWOOD AVE SE
Practice Address - Street 2:T-102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1987
Practice Address - Country:US
Practice Address - Phone:404-680-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor