Individual
DR. GLEN ALLEN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
817 N SMITHFIELD RD, KNIGHTDALE, NC 27545-7717
(919) 217-8188
(919) 217-8189
Mailing address
817 N SMITHFIELD RD, KNIGHTDALE, NC 27545-7717
(919) 217-8188
(919) 217-8189
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3728
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5907457
—
NC
Enumeration date
07/06/2006
Last updated
11/14/2014
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