Individual
DR. RUSSELL N PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
4027 S BUSINESS DR, SHEBOYGAN, WI 53081-1261
(920) 459-9090
(920) 459-7426
Mailing address
4027 S BUSINESS DR, SHEBOYGAN, WI 53081-1261
(920) 459-9090
(920) 459-7426
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4058-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38834800
—
WI
Enumeration date
02/28/2007
Last updated
01/23/2012
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