Individual
DR. NICKALOS LEE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
31 BAILEY AVE, RIDGEFIELD, CT 06877-4533
(203) 438-9609
(203) 438-7141
Mailing address
31 BAILEY AVE, RIDGEFIELD, CT 06877-4533
(203) 438-9609
(203) 438-7141
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
180
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0114667
AETNA HMO ID NUMBER
CT
01
—
050000180CT01
ANTHEM BC/BS ID PROVIDER
CT
01
—
4380815
AETNA PPO ID NUMBER
CT
01
—
9323280003
CIGNA PROVIDER ID NUMBER
CT
01
—
LANDMARK /HEALTH NET
CT00180 PROVIDER ID#
CT
01
—
P405105
OXFORD PROVIDER ID NUMBER
CT
Enumeration date
09/21/2006
Last updated
07/08/2007
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