MEDICARE: DR. PETER KOELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3393	TN

General Provider Information

NPI Number	:	1447927413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER KOELLER

Provider Business Mailing Address
First Line	:	1090 SNOW HILL RD
Second Line	:
City	:	OAKDALE
State	:	TN
Zip	:	37829-2530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1090 SNOW HILL RD
Second Line	:
City	:	OAKDALE
State	:	TN
Zip	:	37829-2530
Country	:	US
Telephone Number	:	920-676-0647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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Directions to “ DR. PETER KOELLER ” Practice Location

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