MEDICARE: DR. LES V 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	CH00002363	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U11492	OTHER	WA	UPIN NUMBER

General Provider Information

NPI Number	:	1952488967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LES V PETERSON DC

Provider Business Mailing Address
First Line	:	415 N OLYMPIC AVE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1244
Country	:	US
Telephone Number	:	360-435-9200
Fax Number	:	360-435-5047

Provider Business Practice Location Address
First Line	:	415 N OLYMPIC AVE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1244
Country	:	US
Telephone Number	:	360-435-9200
Fax Number	:	360-435-5047

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/10/2007

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Directions to “ DR. LES V PETERSON DC” Practice Location

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