MEDICARE: DR. CHRISTOPHER ALLAN 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	6634	MN
2	111N00000X	Chiropractor	CHIR010205	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20263639019	OTHER	GA	GEORGIA

General Provider Information

NPI Number	:	1801442561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ALLAN PETERSON DC

Provider Business Mailing Address
First Line	:	905 JUNIPER ST NE STE 108
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4129
Country	:	US
Telephone Number	:	404-870-0109
Fax Number	:	404-870-0108

Provider Business Practice Location Address
First Line	:	905 JUNIPER ST NE STE 108
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4129
Country	:	US
Telephone Number	:	404-870-0109
Fax Number	:	404-870-0108

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

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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