MEDICARE: 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1841808524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSEN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	5122 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5122 N RHETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4240
Country	:	US
Telephone Number	:	920-205-5180
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATE ELIZABETH PETERSEN
Credential	:	DC
Telephone Number	:	920-205-5180

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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