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Organization
JOHN R. PETERSEN D.C. P.A.
Active
Organization
JOHN R. PETERSEN D.C. P.A.
Active
Other names
Spine & Sports Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT PETERSEN D.C. (DOCTOR OF CHIROPRACTIC)
(651) 639-1066
Entity
Organization
Contact information
Practice address
2216 COUNTY ROAD D W, SAINT PAUL, MN 55112-7500
(651) 639-1066
(651) 630-1069
Mailing address
2216 COUNTY ROAD D W, SAINT PAUL, MN 55112-7500
(651) 639-1066
(651) 630-1069
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4232
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65M39SP
BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/02/2007
Last updated
12/03/2008
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