Provider Demographics
NPI:1255056883
Name:PETERS, DEAN (DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
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 1:12220 BIRMINGHAM HWY STE A
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4184
Mailing Address - Country:US
Mailing Address - Phone:770-751-5700
Mailing Address - Fax:470-745-3159
Practice Address - Street 1:12220 BIRMINGHAM HWY STE A
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-4184
Practice Address - Country:US
Practice Address - Phone:770-751-5700
Practice Address - Fax:470-745-3159
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty