Provider Demographics
NPI:1972937340
Name:GREGORY D PETER D.C. PA
Entity Type:Organization
Organization Name:GREGORY D PETER D.C. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-291-2111
Mailing Address - Street 1:901 NORMAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3770
Mailing Address - Country:US
Mailing Address - Phone:936-291-2111
Mailing Address - Fax:936-291-0665
Practice Address - Street 1:901 NORMAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3770
Practice Address - Country:US
Practice Address - Phone:936-291-2111
Practice Address - Fax:936-291-0665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600912OtherMEDICARE PTAN