Provider Demographics
NPI:1902499197
Name:BIRCH, PETER WILLIAMS
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAMS
Last Name:BIRCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8725
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-8725
Mailing Address - Country:US
Mailing Address - Phone:941-224-9007
Mailing Address - Fax:
Practice Address - Street 1:6350 GULF OF MEXICO DR STE 103B
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-1501
Practice Address - Country:US
Practice Address - Phone:941-899-5937
Practice Address - Fax:941-383-7742
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13327111N00000X
FL13327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor