Individual
DR. JOHN ROBERT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2216 COUNTY ROAD D W, SAINT PAUL, MN 55112-7500
(651) 639-1066
(651) 639-1069
Mailing address
2216 COUNTY ROAD D W, SAINT PAUL, MN 55112-7500
(651) 639-1066
(651) 639-1069
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4232
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411508205
HSM PREFERRED ONE
MN
01
—
65M40PE
BLUE CROSS BLUE SHIELD
MN
05
—
906459100
—
MN
Enumeration date
04/23/2007
Last updated
12/03/2008
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