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General NPI Number Information
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NPI Number | 1811074925
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Entity Type | Individual
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Provider Name | CHRISTINA L. PETERSEN D.C.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 516 ROUTE 303 SUITE 3
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City | ORANGEBURG
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State | NY
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Zip | 10962-1309
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Country | US
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Telephone | 845-398-7771
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Fax | 845-398-7777
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Provider Business Mailing Address
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Address Line | 165 FAWN HILL RD
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City | TUXEDO PARK
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State | NY
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Zip | 10987-3513
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Country | US
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Telephone | 845-351-2965
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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 | X010981
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License Number State | NY
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