Healthcare Provider Details

I. General information

NPI: 1871367458
Provider Name (Legal Business Name): MATTHEW STEVEN PETERSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 NE RIVER RD UNIT 327
OTSEGO MN
55330-8541
US

IV. Provider business mailing address

10235 HICKORYWOOD HILL AVE STE B
HUNTERSVILLE NC
28078-3433
US

V. Phone/Fax

Practice location:
  • Phone: 715-566-3133
  • Fax:
Mailing address:
  • Phone: 704-661-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: