Healthcare Provider Details

I. General information

NPI: 1720440324
Provider Name (Legal Business Name): PETERS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18351 BEACH BLVD SUITE H
HUNTINGTON BEACH CA
92648-1345
US

IV. Provider business mailing address

18351 BEACH BLVD SUITE H
HUNTINGTON BEACH CA
92648-1345
US

V. Phone/Fax

Practice location:
  • Phone: 714-316-3176
  • Fax: 714-908-8028
Mailing address:
  • Phone: 714-316-3176
  • Fax: 714-908-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number32342
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN MATTHEW PETERS
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 714-316-3176