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General NPI Number Information
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NPI Number | 1760697262
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Entity Type | Individual
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Provider Name | CRAIG M PETERSEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 25401 CABOT RD STE 112
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5513
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Country | US
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Telephone | 949-388-1432
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Fax | 949-388-1434
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Provider Business Mailing Address
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Address Line | 31734 RANCHO VIEJO RD SUITE C
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2782
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Country | US
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Telephone | 949-388-1432
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Fax | 949-388-1434
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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 | DC25168
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License Number State | CA
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