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General NPI Number Information
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NPI Number | 1467090290
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Entity Type | Organization
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Legal Business Name | PETERSON CHIROPRACTIC
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Dates
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Enumeration Date | 12/11/2019
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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 STE 140
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City | CHINO HILLS
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State | CA
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Zip | 91709-5567
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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 STE 140
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City | CHINO HILLS
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State | CA
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Zip | 91709-5567
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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 | OWNER
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Name | DR. DERRIK PETERSON
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Credential | DC
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Telephone | 909-334-2230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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