Provider Demographics
NPI:1265609655
Name:PAUL E. PETERS CHIROPRACTIC, INC
Entity type:Organization
Organization Name:PAUL E. PETERS CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-720-1537
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-7176
Mailing Address - Country:US
Mailing Address - Phone:760-720-1537
Mailing Address - Fax:760-734-1565
Practice Address - Street 1:529 CARLSBAD VILLAGE DR, #B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3031
Practice Address - Country:US
Practice Address - Phone:760-720-1537
Practice Address - Fax:760-734-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
CADC26796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80411Medicare UPIN
DC26796Medicare PIN