MEDICARE: DR. CLEOPATRA PETER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	CHIR009177	GA

General Provider Information

NPI Number	:	1639502925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEOPATRA PETER DC

Provider Business Mailing Address
First Line	:	4500 SION FARM STE 8B
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	340-713-2225
Fax Number	:	888-686-4557

Provider Business Practice Location Address
First Line	:	4500 SION FARM STE 8B
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4423
Country	:	US
Telephone Number	:	340-713-2225
Fax Number	:	888-686-4557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	09/28/2021

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Directions to “ DR. CLEOPATRA PETER DC” Practice Location

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