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General NPI Number Information
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NPI Number | 1730930702
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Entity Type | Individual
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Provider Name | TAYLOR PETERSON DC
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Gender | Male
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 2571 CLARE LN NE STE 104
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City | ROCHESTER
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State | MN
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Zip | 55906-8416
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Country | US
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Telephone | 630-379-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 4533 3RD ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3120
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Country | US
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Telephone |
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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 | 6968
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License Number State | MN
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