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General NPI Number Information
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NPI Number | 1871771113
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Entity Type | Individual
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Provider Name | SUZANNE MARIE PETERSEN D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 2351 SUNSET BLVD STE 120
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City | ROCKLIN
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State | CA
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Zip | 95765-4341
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Country | US
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Telephone | 916-624-2500
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Fax | 916-624-4196
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Provider Business Mailing Address
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Address Line | 2351 SUNSET BLVD STE 120
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City | ROCKLIN
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State | CA
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Zip | 95765-4341
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Country | US
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Telephone | 916-624-2500
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Fax | 916-624-4196
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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 | 22539
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License Number State | CA
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