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General NPI Number Information
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NPI Number | 1932656683
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Entity Type | Organization
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Legal Business Name | THERESA R. PETER, P.C.
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 3950 N LOWELL AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2841
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Country | US
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Telephone | 773-481-3950
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Fax |
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Provider Business Mailing Address
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Address Line | 3950 N LOWELL AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2841
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Country | US
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Telephone | 773-481-3950
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. THERESA RENEE PETER
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Credential | D.C., M.S.
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Telephone | 815-385-1851
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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 | 038.011774
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License Number State | IL
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