MEDICARE: SUZANNE PETERSEN CHIROPRACTIC

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	21088	CA

General Provider Information

NPI Number	:	1427302355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE PETERSEN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2351 SUNSET BLVD
Second Line	:	STE 120
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4338
Country	:	US
Telephone Number	:
Fax Number	:	916-624-4196

Provider Business Practice Location Address
First Line	:	2351 SUNSET BLVD
Second Line	:	STE 120
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4338
Country	:	US
Telephone Number	:	916-624-2500
Fax Number	:	916-624-4196

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. TIMOTHY DEE PETERSEN
Credential	:	D.C.
Telephone Number	:	916-624-2500

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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