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General NPI Number Information
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NPI Number | 1194076943
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Entity Type | Organization
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Legal Business Name | PETERSEN CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 3812 4TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-2832
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Country | US
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Telephone | 308-237-7700
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Fax | 308-236-7605
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Provider Business Mailing Address
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Address Line | 3812 4TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-2832
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Country | US
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Telephone | 308-237-7700
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Fax | 308-236-7605
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | RAND A PETERSEN
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Credential | D.C.
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Telephone | 308-237-7700
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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 | 897
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License Number State | NE
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