MEDICARE: GREGORY D PETER D.C. PA

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	TX2637	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600912	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1972937340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY D PETER D.C. PA

Provider Business Mailing Address
First Line	:	901 NORMAL PARK DR
Second Line	:	SUITE 201
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-291-2111
Fax Number	:	936-291-0665

Provider Business Practice Location Address
First Line	:	901 NORMAL PARK DR
Second Line	:	SUITE 201
City	:	HUNTSVILLE
State	:	TX
Zip	:	77320-3770
Country	:	US
Telephone Number	:	936-291-2111
Fax Number	:	936-291-0665

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY DALE PETER
Credential	:	DC
Telephone Number	:	936-291-2111

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/26/2013

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