Individual
DR. JAY JOSEPH PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
701 ELM DRIVE, EDGERTON, WI 53534-1212
(608) 931-5657
Mailing address
701 ELM DRIVE, EDGERTON, WI 53534-1212
(608) 931-5657
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
01-05102
KS
Other
Enumeration date
04/27/2007
Last updated
07/08/2007
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