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Organization
TIMOTHY D PETERSEN CHIROPRACTIC INC.
Active
Organization
TIMOTHY D PETERSEN CHIROPRACTIC INC.
Active
Other names
Stanford Ranch Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY DEE PETERSEN D.C. (PRESIDENT)
(916) 625-2500
Entity
Organization
Contact information
Practice address
2351 SUNSET BLVD STE 120, ROCKLIN, CA 95765-4341
(916) 624-2500
(916) 624-4196
Mailing address
2351 SUNSET BLVD STE 120, ROCKLIN, CA 95765-4341
(916) 624-2500
(916) 624-4196
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
21088
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891853453
NPI NUMBER
CA
01
—
DC0210880
MEDICARE PROVIDER NUMBER
CA
Enumeration date
08/24/2011
Last updated
08/24/2011
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