Provider Demographics
NPI:1780681320
Name:SPATHIS, PETER (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SPATHIS
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 1:903 E CLINTON ST
Mailing Address - Street 2:STE 103
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1871
Mailing Address - Country:US
Mailing Address - Phone:517-552-0890
Mailing Address - Fax:517-552-0891
Practice Address - Street 1:903 E CLINTON ST
Practice Address - Street 2:STE 103
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1871
Practice Address - Country:US
Practice Address - Phone:517-552-0890
Practice Address - Fax:517-552-0891
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D750390OtherBLUE CROSS BLUE SHIELD
MI2134226OtherFIRST HEALTH
MI133267OtherPREFERRED CHOICES PPO
MI2301008213OtherMI STATE CHIRO. LICENSE #
MIP114668OtherBLUE CARE NETWORK
MI2301008213OtherMI STATE CHIRO. LICENSE #
MI133267OtherPREFERRED CHOICES PPO