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Organization

PETERSEN CHIROPRACTIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CLINTON JEROME PETERSEN D.C. (DOCTOR/OWNER)
(307) 686-0303
Entity
Organization

Contact information

Practice address
3805 S DOUGLAS HWY, UNIT # 2, GILLETTE, WY 82718-6554
(307) 686-0303
(307) 686-2882
Mailing address
3805 S DOUGLAS HWY, UNIT # 2, GILLETTE, WY 82718-6554
(307) 686-0303
(307) 686-2882

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
623
WY

Other

Enumeration date
08/23/2010
Last updated
08/23/2010
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