Healthcare Provider Details

I. General information

NPI: 1710138292
Provider Name (Legal Business Name): JAMES PETERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W344 HIGHWAY DW
THERESA WI
53091-9777
US

IV. Provider business mailing address

W344 HIGHWAY DW
THERESA WI
53091-9777
US

V. Phone/Fax

Practice location:
  • Phone: 262-623-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4445-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: