MEDICARE: PHILIP C PETERSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC15845	CA

General Provider Information

NPI Number	:	1225167109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP C PETERSON DC

Provider Business Mailing Address
First Line	:	1924 SPRING ST
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1620
Country	:	US
Telephone Number	:	805-237-1924
Fax Number	:	805-237-1953

Provider Business Practice Location Address
First Line	:	1924 SPRING ST
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-1620
Country	:	US
Telephone Number	:	805-237-1924
Fax Number	:	805-237-1953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	10/14/2010

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