Provider Demographics
NPI:1013283696
Name:PETERS, MICHELLE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NICOLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:N
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3330 MATLOCK RD
Mailing Address - Street 2:STE 206
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2921
Mailing Address - Country:US
Mailing Address - Phone:817-465-2225
Mailing Address - Fax:817-719-9342
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2921
Practice Address - Country:US
Practice Address - Phone:817-465-2225
Practice Address - Fax:817-719-9342
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor