Individual
GREGORY J. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
215 2ND ST SE, ORTONVILLE, MN 56278-1537
(320) 839-2323
(320) 839-2323
Mailing address
215 2ND ST SE, ORTONVILLE, MN 56278-1537
(320) 839-2323
(320) 839-2323
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1992
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030701023
PRIME WEST MED ASSISTANCE
MN
01
—
1B090PE
BCBS INDIVIDUAL PROVIDER
MN
01
—
20341
SIOUX VALLEY HEALTH PLAN
MN
01
—
230676
ACN PROVIDER NUMBER
MN
01
—
350048036
RR MEDICARE
MN
01
—
391886617
TRIAD
MN
01
—
49317PE
BCBS CLINIC/GROUP NUMBER
MN
05
—
595727300
—
MN
01
—
7602140
SD MEDICAL ASSISTANCE
MN
Enumeration date
10/12/2006
Last updated
01/12/2012
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