Provider Demographics
NPI:1780735779
Name:PETERS CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:PETERS CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-943-7352
Mailing Address - Street 1:8404 W. 13TH ST.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212
Mailing Address - Country:US
Mailing Address - Phone:316-943-7352
Mailing Address - Fax:316-946-5991
Practice Address - Street 1:8404 W 13TH ST N
Practice Address - Street 2:SUITE 150
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2978
Practice Address - Country:US
Practice Address - Phone:316-943-7352
Practice Address - Fax:316-946-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060048Medicare ID - Type Unspecified
KST44108Medicare UPIN