Provider Demographics
NPI:1932728417
Name:PEPER, DUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:PEPER
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 1:1222 PRAY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8717
Mailing Address - Country:US
Mailing Address - Phone:419-878-8142
Mailing Address - Fax:
Practice Address - Street 1:1222 PRAY BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8717
Practice Address - Country:US
Practice Address - Phone:419-878-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor