MEDICARE: DR. MICHAEL S PETERS D.C.

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	111N00000X	Chiropractor	2900	OR

General Provider Information

NPI Number	:	1811216872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S PETERS D.C.

Provider Business Mailing Address
First Line	:	1218 NW 21ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1609
Country	:	US
Telephone Number	:	503-226-2574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 NW 21ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-1609
Country	:	US
Telephone Number	:	503-226-2574
Fax Number	:

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

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/28/2010

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