Healthcare Provider Details

I. General information

NPI: 1487953931
Provider Name (Legal Business Name): B. PETERSON CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N 400 E STE 106
LOGAN UT
84341-7595
US

IV. Provider business mailing address

1515 N 400 E STE 106
LOGAN UT
84341-7595
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-1787
  • Fax: 435-787-1797
Mailing address:
  • Phone: 435-787-1787
  • Fax: 435-787-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2722961202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number7330185701
License Number StateUT

VIII. Authorized Official

Name: DR. BRENT PETERSON
Title or Position: OWNER
Credential: D.C.
Phone: 435-787-1787