MEDICARE: PETERS CHIROPRACTIC CORPORATION

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	DC32342	CA

General Provider Information

NPI Number	:	1821538695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERS CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	18351 BEACH BLVD STE H
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1347
Country	:	US
Telephone Number	:	714-465-9173
Fax Number	:	714-908-8028

Provider Business Practice Location Address
First Line	:	18351 BEACH BLVD STE H
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1347
Country	:	US
Telephone Number	:	714-465-9173
Fax Number	:	714-908-8028

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN PETERS
Credential	:	D.C
Telephone Number	:	714-465-9173

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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