MEDICARE: PETER DIDERICK AHLERS-NELSON 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	5395	MN

General Provider Information

NPI Number	:	1881028868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER DIDERICK AHLERS-NELSON D.C.

Provider Business Mailing Address
First Line	:	101 5TH ST E
Second Line	:	STE 204
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2067
Country	:	US
Telephone Number	:	507-581-4721
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 5TH ST E
Second Line	:	STE 204
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2067
Country	:	US
Telephone Number	:	507-581-4721
Fax Number	:

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

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	08/27/2013

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