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Individual
MARY PETERSON
Active
Individual
MARY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
0104556711
VA
111N00000X
Chiropractor
Primary
038.008605
IL
111N00000X
Chiropractor
2301007900
MI
224L00000X
Pedorthist
212.000204
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950G010660
BCBS
MI
Enumeration date
11/17/2006
Last updated
12/02/2022
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