=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013731371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN PETERSON DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 E BAILEY BOSWELL RD STE 150
-----------------------------------------------------
City | FT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76131-3573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-482-3388
-----------------------------------------------------
Fax | 817-704-0393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 E BAILEY BOSWELL RD STE 150
-----------------------------------------------------
City | FT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76131-3573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-482-3388
-----------------------------------------------------
Fax | 817-704-0393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 14380
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------