Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7767 | AZ |
N | 111NN1001X | Nutrition | DC-29747 | CA |
NPI | 1366448912 |
---|---|
Provider Name | Dr. Troy Henry Peters |
First Address | Goodyear, AZ 85395-1252 |
Second Address | Goodyear, AZ 85395-1287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 18/04/2014 |