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General NPI Number Information
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NPI Number | 1114136140
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Entity Type | Organization
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Legal Business Name | PETERSON CHIROPRACTIC INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3200 PINE LAKE RD SUITE B
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City | LINCOLN
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State | NE
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Zip | 68516-6035
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Country | US
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Telephone | 402-423-5050
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Fax | 402-423-5065
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Provider Business Mailing Address
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Address Line | 3200 PINE LAKE RD SUITE B
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City | LINCOLN
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State | NE
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Zip | 68516-6035
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Country | US
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Telephone | 402-423-5050
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Fax | 402-423-5065
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEREMY RYAN PETERSON
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Credential | D.C.
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Telephone | 402-423-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1372
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License Number State | NE
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