Organization
BRISTLECONE CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES TYLER PETERSEN DC (MEMBER)
(435) 592-4845
Entity
Organization
Contact information
Practice address
657 W 200 N, CEDAR CITY, UT 84720-2408
(435) 592-4845
Mailing address
657 W 200 N, CEDAR CITY, UT 84720-2408
(435) 592-4845
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
7779072-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U000073714
PTAN
UT
Enumeration date
03/08/2011
Last updated
03/20/2012
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