Healthcare Provider Details

I. General information

NPI: 1629149968
Provider Name (Legal Business Name): PETERS WELLNESS CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N LITCHFIELD RD SUITE 210
GOODYEAR AZ
85338-1252
US

IV. Provider business mailing address

1616 N LITCHFIELD RD SUITE 210
GOODYEAR AZ
85338-1252
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-0911
  • Fax: 623-935-0921
Mailing address:
  • Phone: 623-935-0911
  • Fax: 623-935-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC-29747
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number7767
License Number StateAZ

VIII. Authorized Official

Name: DR. TROY HENRY PETERS
Title or Position: CEO
Credential: D.C.
Phone: 623-935-0911