Individual
DR. MICHAEL MAURITZ PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1414 S OAK AVE, SUITE #4, OWATONNA, MN 55060-3957
(507) 455-0199
(507) 455-9224
Mailing address
1414 S. OAK AVE, SUITE #4, OWATONNA, MN 55060-3957
(507) 455-0199
(507) 455-9224
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4322
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11B57PE
BLUE CROSS BLUE SHIELD OF MINNESOTA
MN
05
—
1366447500
—
MN
Enumeration date
11/02/2006
Last updated
03/21/2012
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