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Organization
CHARLES J PETERSON DC PC
Active
Organization
CHARLES J PETERSON DC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J PETERSON DC (PRESIDENT)
(712) 246-4798
Entity
Organization
Contact information
Practice address
1203 W SHERIDAN AVE, SHENANDOAH, IA 51601
(712) 246-4798
(712) 246-5613
Mailing address
1203 W SHERIDAN AVE, SHENANDOAH, IA 51601
(712) 246-4798
(712) 246-5613
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
04065
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015271
—
IA
01
—
01527
WELLMARK
IA
Enumeration date
02/13/2006
Last updated
08/22/2020
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