Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 514 | VA |
NPI | 1376652917 |
---|---|
Provider Name | Dr. Peter Joseph Stanton |
First Address | Burke, VA 22015-2234 |
Second Address | Burke, VA 22015-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |