Individual
DIANE M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1205 HAUCK DR, ROLLA, MO 65401-4900
(573) 426-2225
(573) 426-2290
Mailing address
1312 WOODLAWN DR, ROLLA, MO 65401-2521
(573) 426-3418
(573) 426-2290
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2003008890
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
182589
BLUE CROSS BLUE SHIELD
MO
01
—
660783
UNITED HEALTHCARE
MO
Enumeration date
11/28/2006
Last updated
07/08/2007
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