Healthcare Provider Details

I. General information

NPI: 1588080329
Provider Name (Legal Business Name): PETER HUGHES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E GUADALUPE RD SUITE 112
TEMPE AZ
85283-3273
US

IV. Provider business mailing address

1101 AUGUSTA DR SE
MARIETTA GA
30067-4448
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-8552
  • Fax:
Mailing address:
  • Phone: 678-300-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8376
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: