Individual
DR. JON B PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2611 CLEARWATER RD, SAINT CLOUD, MN 56301-5953
(320) 656-0200
(320) 656-0204
Mailing address
2611 CLEARWATER RD, SAINT CLOUD, MN 56301-5953
(320) 656-0200
(320) 656-0204
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4221
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406S4MI
BCBS
MN
01
—
P00039673
RAILROAD MEDICARE
MN
Enumeration date
12/12/2006
Last updated
07/08/2007
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