Provider Demographics
NPI:1720095946
Name:PETERS, RICHARD J (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
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 1:3100 TIMMONS LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5926
Mailing Address - Country:US
Mailing Address - Phone:713-355-5343
Mailing Address - Fax:
Practice Address - Street 1:3100 TIMMONS LN
Practice Address - Street 2:SUITE 135
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5926
Practice Address - Country:US
Practice Address - Phone:713-355-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603523Medicare PIN
TXU26445Medicare UPIN