Provider Demographics
NPI:1902262470
Name:PETERS, TREVOR (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 WILLOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8528
Mailing Address - Country:US
Mailing Address - Phone:515-368-4049
Mailing Address - Fax:
Practice Address - Street 1:2316 230TH ST STE 102
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-6329
Practice Address - Country:US
Practice Address - Phone:515-368-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor