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General NPI Number Information
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NPI Number | 1114581394
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Entity Type | Individual
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Provider Name | DERRIK BRIAN PETERSON DC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 15911 POMONA RINCON RD
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City | CHINO HILLS
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State | CA
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Zip | 91709-5566
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Country | US
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Telephone | 909-334-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 15911 POMONA RINCON RD
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City | CHINO HILLS
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State | CA
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Zip | 91709-5566
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Country | US
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Telephone | 909-334-2230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 34377
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License Number State | CA
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