Organization
GARY L. PETERSON D.C.PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY LEE PETERSN D.C. (CHIROPRACTIC PHYSICIAN)
(505) 883-5858
Entity
Organization
Contact information
Practice address
7100 MENAUL BLVD NE, ALBUQUERQUE, NM 87110-3688
(505) 883-5858
(505) 883-0010
Mailing address
7100 MENAUL BLVD NE, ALBUQUERQUE, NM 87110-3688
(505) 883-5858
(505) 883-0010
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K7169
—
NM
Enumeration date
04/10/2012
Last updated
04/10/2012
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