Provider Demographics
NPI:1487707162
Name:STERN, PETER MARC (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARC
Last Name:STERN
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3222
Mailing Address - Country:US
Mailing Address - Phone:707-923-3644
Mailing Address - Fax:707-923-1325
Practice Address - Street 1:764 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3222
Practice Address - Country:US
Practice Address - Phone:707-923-3644
Practice Address - Fax:707-923-1325
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2809171100000X
CAND-46175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0028090Medicaid