MEDICARE: DR. ERIK D PETERSON D.C.

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	38010289	IL

General Provider Information

NPI Number	:	1841225679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK D PETERSON D.C.

Provider Business Mailing Address
First Line	:	2706 WOODLAWN RD
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-4100
Country	:	US
Telephone Number	:	815-535-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 E LINCOLNWAY STE B
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-9740
Country	:	US
Telephone Number	:	815-535-9900
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/18/2019

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