MEDICARE: HOWARD GALE PETERSEN 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	1759	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4100327	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528168382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD GALE PETERSEN DC

Provider Business Mailing Address
First Line	:	807 E JACKSON BLVD
Second Line	:	SUITE TWO
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:	423-753-4964
Fax Number	:	423-753-4121

Provider Business Practice Location Address
First Line	:	807 E JACKSON BLVD
Second Line	:	SUITE TWO
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:	423-753-4964
Fax Number	:	423-753-4121

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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