Healthcare Provider Details

I. General information

NPI: 1194076281
Provider Name (Legal Business Name): FAITH E PETERMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 MONROVIA ST
SHAWNEE KS
66216-2740
US

IV. Provider business mailing address

6308 MONROVIA ST
SHAWNEE KS
66216-2740
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-8888
  • Fax: 913-962-1627
Mailing address:
  • Phone: 913-631-8888
  • Fax: 913-962-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberT-03462
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2001005092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: