Provider Demographics
NPI:1548276041
Name:WARNER, PETER JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:WARNER
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 1:1113 S SCURRY ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-4301
Mailing Address - Country:US
Mailing Address - Phone:432-267-2225
Mailing Address - Fax:432-267-2228
Practice Address - Street 1:1510 SCURRY ST
Practice Address - Street 2:SUITE C
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4301
Practice Address - Country:US
Practice Address - Phone:432-606-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612142Medicare ID - Type Unspecified
TXV07713Medicare UPIN