Organization
PETERSEN FAMILY CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD PETERSEN DC (OWNER)
(423) 753-4964
Entity
Organization
Contact information
Practice address
807 E JACKSON BLVD STE 2, JONESBOROUGH, TN 37659-1507
(423) 753-4964
Mailing address
807 E JACKSON BLVD STE 2, JONESBOROUGH, TN 37659-1507
(423) 753-4964
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC1759
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3971212
—
TN
01
—
4100327
BCBS OF TN
TN
01
—
P00218796
RAILROAD MEDICARE
TN
Enumeration date
03/14/2007
Last updated
01/04/2008
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