MEDICARE: PETERSON CHIROPRACTIC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1467090290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSON CHIROPRACTIC

Provider Business Mailing Address
First Line	:	15911 POMONA RINCON RD STE 140
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5567
Country	:	US
Telephone Number	:	909-334-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	15911 POMONA RINCON RD STE 140
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5567
Country	:	US
Telephone Number	:	909-334-2230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DERRIK PETERSON
Credential	:	DC
Telephone Number	:	909-334-2230

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	08/13/2020

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