Provider Demographics
NPI:1881775005
Name:MEYER, PETER CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHARLES
Last Name:MEYER
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 1:5261 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4656
Mailing Address - Country:US
Mailing Address - Phone:773-725-4979
Mailing Address - Fax:773-725-4879
Practice Address - Street 1:5261 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4656
Practice Address - Country:US
Practice Address - Phone:773-725-4979
Practice Address - Fax:773-725-4879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006215111NS0005X
IL038006215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT871291Medicare UPIN
IL908000Medicare ID - Type Unspecified