MEDICARE: KALA M 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	DC37384	CA
2	111N00000X	Chiropractor	CH14064	FL

General Provider Information

NPI Number	:	1306583828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALA M PETERSON DC

Provider Business Mailing Address
First Line	:	7290 NAVAJO RD STE 109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1631
Country	:	US
Telephone Number	:	619-320-5639
Fax Number	:

Provider Business Practice Location Address
First Line	:	7290 NAVAJO RD STE 109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1631
Country	:	US
Telephone Number	:	619-320-5639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	03/09/2026

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Directions to “ KALA M PETERSON DC” Practice Location

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