Healthcare Provider Details

I. General information

NPI: 1720185176
Provider Name (Legal Business Name): PETER GEORGIOU D.C., CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER GEORGIOU D.C, CCSP

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/04/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W BELMONT AVE
CHICAGO IL
60657-4427
US

IV. Provider business mailing address

916 W. BELMONT
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-4400
  • Fax: 773-665-4439
Mailing address:
  • Phone: 773-665-4400
  • Fax: 773-665-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038007148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: