Healthcare Provider Details

I. General information

NPI: 1841808524
Provider Name (Legal Business Name): PETERSEN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 N RHETT AVE
NORTH CHARLESTON SC
29405-4240
US

IV. Provider business mailing address

5122 N RHETT AVE
NORTH CHARLESTON SC
29405-4240
US

V. Phone/Fax

Practice location:
  • Phone: 920-205-5180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATE ELIZABETH PETERSEN
Title or Position: OWNER
Credential: DC
Phone: 920-205-5180