Individual
BRAD NIEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
10358 S REDWOOD RD, SOUTH JORDAN, UT 84095-9339
(801) 254-9400
(801) 254-5739
Mailing address
10358 S REDWOOD RD, SOUTH JORDAN, UT 84095-9339
(801) 254-9400
(801) 254-5739
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
176210-1202
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612239
UNITED HEALTHCARE
UT
05
—
870503754002
—
UT
Enumeration date
07/19/2006
Last updated
12/16/2010
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