Individual
DR. ANICIA GWEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
13743 E SHORE RD, CROSSLAKE, MN 56442-4033
(218) 692-1616
(218) 692-1626
Mailing address
13743 E SHORE RD, CROSSLAKE, MN 56442-4033
(218) 692-1616
(218) 692-1626
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3138
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68D24NO
BCBS OFFICE ID #
MN
01
—
68D25PE
BCBS INDIVIDUAL ID #
MN
Enumeration date
01/02/2007
Last updated
07/09/2007
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