Individual
JESSE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
2151 HAMLINE AVE N STE 108, ROSEVILLE, MN 55113-4226
(612) 242-9630
Mailing address
2151 HAMLINE AVE N, SUITE 108, ROSEVILLE, MN 55113-4236
(612) 242-9630
(651) 636-6110
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
1333
MN
Other
Enumeration date
03/29/2007
Last updated
03/31/2011
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