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General NPI Number Information
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NPI Number | 1376377655
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Entity Type | Individual
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Provider Name | ANTHONY L PETERSON DC
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Gender | Male
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 5220 DOUGLAS BLVD
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City | GRANITE BAY
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State | CA
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Zip | 95746-6205
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Country | US
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Telephone | 707-430-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 1253 SENEGAL WAY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-6402
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Country | US
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Telephone | 707-430-3740
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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 | 35241
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License Number State | CA
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