Organization
M & K ETC INC
Active
Other names
Elma Chiroptactic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW S PETERSON DC (CHIROPRACTOR)
(360) 482-5155
Entity
Organization
Contact information
Practice address
103 N 1ST STREET, ELMA, WA 98541
(360) 482-5155
(360) 482-4155
Mailing address
PO BOX 656, ELMA, WA 98541
(360) 482-5155
(360) 482-4155
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2953781202
UT
111N00000X
Chiropractor
Primary
CH00003029
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020535
—
WA
01
—
346230001
GROUP HEALTH
WA
01
—
46871
L & I
WA
Enumeration date
02/12/2007
Last updated
06/12/2008
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