Provider Demographics
NPI:1730224148
Name:LIND, PETER (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LIND
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 1:1707 LANSING AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8732
Mailing Address - Country:US
Mailing Address - Phone:503-581-6846
Mailing Address - Fax:
Practice Address - Street 1:1707 LANSING AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-1632
Practice Address - Country:US
Practice Address - Phone:503-581-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGFCLMedicare ID - Type UnspecifiedMEDICARE