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General NPI Number Information
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NPI Number | 1497893911
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Entity Type | Organization
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Legal Business Name | PETER FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 750 HIGHWAY 110 STE 13
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City | MENDOTA HGTS
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State | MN
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Zip | 55120
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Country | US
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Telephone | 651-452-8333
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Fax | 651-452-0387
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Provider Business Mailing Address
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Address Line | 750 HIGHWAY 110 STE 13
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City | MENDOTA HGTS
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State | MN
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Zip | 55120
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Country | US
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Telephone | 651-452-8333
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Fax | 651-452-0387
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VICKI J ARMSTRONG
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Credential |
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Telephone | 651-452-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2801
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License Number State | MN
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