Individual
JACOB AARON PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
434 N STAR RD, HOLMEN, WI 54636-4402
(608) 526-3343
(608) 526-9366
Mailing address
PO BOX 274, PITTSVILLE, WI 54466-0274
(715) 884-2379
(715) 884-2411
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4137-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38961300
—
WI
01
—
P00600196
MEDICARE RAILROAD
WI
Enumeration date
07/24/2006
Last updated
07/11/2016
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