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General NPI Number Information
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NPI Number | 1871515593
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Entity Type | Individual
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Provider Name | JACOB AARON PETERSON DC
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 434 N STAR RD
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City | HOLMEN
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State | WI
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Zip | 54636-4402
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Country | US
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Telephone | 608-526-3343
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Fax | 608-526-9366
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Provider Business Mailing Address
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Address Line | PO BOX 274
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City | PITTSVILLE
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State | WI
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Zip | 54466-0274
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Country | US
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Telephone | 715-884-2379
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Fax | 715-884-2411
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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 | 4137-012
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License Number State | WI
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