Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X005752-1 | NY |
NPI | 1073661369 |
---|---|
Provider Name | Dr. Peter Chambers |
First Address | Freeport, NY 11520-6215 |
Second Address | Freeport, NY 11520-4337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |