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Individual
GREGORY J. PETERSON
Active
Individual
GREGORY J. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1992
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030701023
PRIME WEST MED ASSISTANCE
MN
01
—
1B090PE
BCBS INDIVIDUAL PROVIDER
MN
01
—
20341
SIOUX VALLEY HEALTH PLAN
MN
01
—
230676
ACN PROVIDER NUMBER
MN
01
—
350048036
RR MEDICARE
MN
01
—
391886617
TRIAD
MN
01
—
49317PE
BCBS CLINIC/GROUP NUMBER
MN
05
—
595727300
—
MN
01
—
7602140
SD MEDICAL ASSISTANCE
MN
Enumeration date
10/12/2006
Last updated
01/12/2012
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