Healthcare Provider Details

I. General information

NPI: 1801701370
Provider Name (Legal Business Name): BRANDON MICHAEL PETERSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E MAIN ST
MIDDLETOWN DE
19709-1463
US

IV. Provider business mailing address

102 METCALF RD
CHESTERTOWN MD
21620-1024
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-5830
  • Fax:
Mailing address:
  • Phone: 386-276-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0011180
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: