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General NPI Number Information
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NPI Number | 1457741225
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Entity Type | Individual
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Provider Name | AMANDA PETERSON DC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1820 FULLERTON AVE STE 250
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City | CORONA
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State | CA
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Zip | 92881
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Country | US
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Telephone | 951-818-3084
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Fax |
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Provider Business Mailing Address
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Address Line | 11748 MAGNOLIA AVE STE C1
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City | RIVERSIDE
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State | CA
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Zip | 92503-4955
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Country | US
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Telephone | 951-818-3084
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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 | DC31866
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | DC31866
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License Number State | CA
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