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Individual

CARL R PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
113 CENTRAL AVE, COON VALLEY CHIROPRACTIC, COON VALLEY, WI 54623
(608) 452-2525
(608) 452-2526
Mailing address
113 CENTRAL AVE, COON VALLEY CHIROPRACTIC, COON VALLEY, WI 54623
(608) 452-2525
(608) 452-2526

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3132
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006
MEDICARE SEQUENCE #
WI
01
263J1PE
BC/BS MN #
MN
01
350041526
RR MEDICARE #
WI
05
38880400
WI
Enumeration date
03/31/2006
Last updated
02/06/2012
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