Provider Demographics
NPI:1881814051
Name:PETROPULOS, PETER MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:PETROPULOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12476 GREENLAND ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118-6130
Mailing Address - Country:US
Mailing Address - Phone:303-681-2523
Mailing Address - Fax:303-689-0187
Practice Address - Street 1:7200 E. DRY CREEK RD.
Practice Address - Street 2:SUITE A101
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-850-0880
Practice Address - Fax:303-689-0387
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2292111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1865-3Medicare UPIN