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General NPI Number Information
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NPI Number | 1477821783
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Entity Type | Organization
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Legal Business Name | PETERSON CHIROPRACTIC CLINIC OF OSHKOSH, SC
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1765 TAFT AVE
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City | OSHKOSH
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State | WI
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Zip | 54902-3220
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Country | US
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Telephone | 920-233-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 1765 TAFT AVE
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City | OSHKOSH
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State | WI
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Zip | 54902-3220
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Country | US
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Telephone | 920-233-7744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS PETERSON
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Credential |
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Telephone | 920-233-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1804
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License Number State | WI
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