MEDICARE: PETERSEN FAMILY 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	111N00000X	Chiropractor	DC1759	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00218796	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1841323276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSEN FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	807 E JACKSON BLVD STE 2
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:	423-753-4964
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E JACKSON BLVD STE 2
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1507
Country	:	US
Telephone Number	:	423-753-4964
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HOWARD PETERSEN
Credential	:	DC
Telephone Number	:	423-753-4964

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	01/04/2008

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Directions to “PETERSEN FAMILY CHIROPRACTIC ” Practice Location

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