Organization
PETTERSON CHIROPRACTIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD JEREMY PETTERSON DC (OWNER PRESIDENT)
(651) 480-1128
Entity
Organization
Contact information
Practice address
825 BAHLS DRIVE, HASTINGS, MN 55033
(651) 480-1128
(651) 438-3929
Mailing address
825 BAHLS DRIVE, HASTINGS, MN 55033
(651) 480-1128
(651) 438-3929
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3748
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10G0179
HEALTH PARTNERS
MN
01
—
198G8PE
BLUE CROSS BLUE SHIELD #
MN
01
—
C03874
MEDICARE GROUP #
MN
Enumeration date
11/08/2006
Last updated
08/22/2020
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