MEDICARE: MR. DALE PETERSEN 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	1833	CO

General Provider Information

NPI Number	:	1306906169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE PETERSEN DC

Provider Business Mailing Address
First Line	:	1923 E KENTUCKY AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4554
Country	:	US
Telephone Number	:	303-722-2273
Fax Number	:	303-282-7597

Provider Business Practice Location Address
First Line	:	1923 E KENTUCKY AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4554
Country	:	US
Telephone Number	:	303-722-2273
Fax Number	:	303-282-7597

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/05/2008

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Directions to “ MR. DALE PETERSEN DC” Practice Location

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