Individual
DR. ROBERT TODD PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, OPAC, ATC, LAT
Contact information
Practice address
3408 MILTON AVE, DALLAS, TX 75205-1338
(214) 739-2225
(214) 739-2228
Mailing address
3408 MILTON AVE, DALLAS, TX 75205-1338
(214) 739-2225
(214) 739-2228
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
5118449-1202
UT
111NS0005X
Sports Physician Chiropractor
Primary
9289
TX
363A00000X
Physician Assistant
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
607194
BCBS ID NUMBER
TX
Enumeration date
07/20/2006
Last updated
10/30/2014
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