Organization
SPORTS AND SPINE THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT TODD PETERSEN DC, OPA-C, CCSP, ATC (PROPRIETOR)
(214) 739-2225
Entity
Organization
Contact information
Practice address
7830 N CENTRAL EXPY, DALLAS, TX 75206-1902
(214) 739-2225
(214) 739-2228
Mailing address
7830 N CENTRAL EXPY, DALLAS, TX 75206-1902
(214) 739-2225
(214) 739-2228
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AS200
BCBS
TX
Enumeration date
07/02/2007
Last updated
02/05/2009
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