Individual
JEREMY R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3200 PINE LAKE RD, SUITE B, LINCOLN, NE 68516-6035
(402) 423-5050
(402) 423-5065
Mailing address
3200 PINE LAKE RD, SUITE B, LINCOLN, NE 68516-6035
(402) 423-5050
(402) 423-5065
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1372
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025223200
—
NE
Enumeration date
11/02/2006
Last updated
07/08/2007
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