MEDICARE: DR. PETER SANTO ANNYSCHYN D.C.

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	111NS0005X	Sports Physician Chiropractor	2301005955	MI

General Provider Information

NPI Number	:	1760481261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER SANTO ANNYSCHYN D.C.

Provider Business Mailing Address
First Line	:	15123 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-3030
Country	:	US
Telephone Number	:	313-886-1111
Fax Number	:	313-886-0223

Provider Business Practice Location Address
First Line	:	15123 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-3030
Country	:	US
Telephone Number	:	313-886-1111
Fax Number	:	313-886-0223

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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