Provider Demographics
NPI:1235121161
Name:WARNER, PETER (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:WARNER
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 BRUNSWICK RD
Mailing Address - Street 2:5
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9544
Mailing Address - Country:US
Mailing Address - Phone:530-273-6192
Mailing Address - Fax:530-273-6565
Practice Address - Street 1:563 BRUNSWICK RD
Practice Address - Street 2:5
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7801
Practice Address - Country:US
Practice Address - Phone:530-273-6192
Practice Address - Fax:530-273-6565
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 112570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0112570Medicare ID - Type Unspecified
CADC0112570Medicare PIN
CAT04260Medicare UPIN