Provider Demographics
NPI:1720440324
Name:PETERS CHIROPRACTIC
Entity Type:Organization
Organization Name:PETERS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-316-3176
Mailing Address - Street 1:18351 BEACH BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1345
Mailing Address - Country:US
Mailing Address - Phone:714-316-3176
Mailing Address - Fax:714-908-8028
Practice Address - Street 1:18351 BEACH BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1345
Practice Address - Country:US
Practice Address - Phone:714-316-3176
Practice Address - Fax:714-908-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32342111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty