MEDICARE: JEREMY R PETERSON DC

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	:	1285713248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY R PETERSON DC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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