MEDICARE: PETERSON CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1372	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114136140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	3200 PINE LAKE RD
Second Line	:	SUITE B
City	:	LINCOLN
State	:	NE
Zip	:	68516-6035
Country	:	US
Telephone Number	:	402-423-5050
Fax Number	:	402-423-5065

Provider Business Practice Location Address
First Line	:	3200 PINE LAKE RD
Second Line	:	SUITE B
City	:	LINCOLN
State	:	NE
Zip	:	68516-6035
Country	:	US
Telephone Number	:	402-423-5050
Fax Number	:	402-423-5065

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMY RYAN PETERSON
Credential	:	D.C.
Telephone Number	:	402-423-5050

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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Directions to “PETERSON CHIROPRACTIC INC ” Practice Location

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