100 Chiro Peterson Ruiz PLLC
Organization Active NPI Chiropractor · Fairview, TX
NPI 1801528708 · NPPES record last updated Apr 30, 2024
Key facts
- NPI
- 1801528708
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- 100 CHIRO PETERSON RUIZ PLLC
- Practice address
- 117 Whistlestop Way
Unit 3
Fairview, TX 75069 - Phone
- (719) 217-0895
- NPI assigned
- Jun 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr Michael Peterson
- Title
- Owner
- Phone
- (719) 251-7708
Practitioners 2
-
Michael Peterson, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240104004606 | TX | Part B Supplier - Clinic/Group Practice | 3173974029 |
Receives reassigned benefits from 1 practitioner Practice locations: Fairview, TX |
National Provider Directory
Locations
117 Whistlestop Way
Unit 3
Fairview, TX 75069
Phone (469) 210-5402
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
117 Whistlestop Way
Unit 3
Fairview, TX 75069
Mailing address
117 Whistlestop Way
Unit 3
Fairview, TX 75069
Other providers in Fairview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.