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General NPI Number Information
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NPI Number | 1740578285
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Entity Type | Organization
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Legal Business Name | PETERS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 1704 S BOULEVARD SUITE B
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-285-6418
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Fax | 405-385-6419
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Provider Business Mailing Address
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Address Line | 1704 S BOULEVARD SUITE B
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-285-6418
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Fax | 405-385-6419
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | DR. RANCE EDWARD PETERS
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Credential | D.C.
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Telephone | 405-285-6418
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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 | 4023
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License Number State | OK
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