MEDICARE: MR. DANNY KEITH 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	CE003799	MO

General Provider Information

NPI Number	:	1952480998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANNY KEITH PETERSON DC

Provider Business Mailing Address
First Line	:	16101 OLD 63 SOUTH
Second Line	:
City	:	ASHLAND
State	:	MO
Zip	:	65010-9477
Country	:	US
Telephone Number	:	573-657-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E MCCARTY ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3324
Country	:	US
Telephone Number	:	573-634-3245
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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