MEDICARE: JOHN S PETERSON DC A CHIROPRACTIC CORPORATION

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	DC17788	CA

General Provider Information

NPI Number	:	1548653819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN S PETERSON DC A CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	1309 S EUCLID ST
Second Line	:	STE A
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2078
Country	:	US
Telephone Number	:	714-776-7111
Fax Number	:	714-776-9693

Provider Business Practice Location Address
First Line	:	1309 S EUCLID ST
Second Line	:	STE A
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2078
Country	:	US
Telephone Number	:	714-776-7111
Fax Number	:	714-776-9693

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN STEVEN PETERSON
Credential	:	D.C.
Telephone Number	:	714-776-7111

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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