Individual
DR. GLEN R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
501 1ST ST, LA SALLE, IL 61301-2416
(815) 223-4201
(814) 223-4210
Mailing address
PO BOX 1204, LA SALLE, IL 61301-3204
(815) 223-4201
(815) 223-4210
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038-008373
IL
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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