Healthcare Provider Details

I. General information

NPI: 1629666599
Provider Name (Legal Business Name): PEET CHIROPRACTIC HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26933 CAMINO DE ESTRELLA STE B
CAPISTRANO BEACH CA
92624-1680
US

IV. Provider business mailing address

26933 CAMINO DE ESTRELLA STE B
CAPISTRANO BEACH CA
92624-1680
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-4955
  • Fax:
Mailing address:
  • Phone: 802-922-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PALMER M PEET
Title or Position: PRESIDENT
Credential: D.C.
Phone: 802-922-4955