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Individual

KEITH A PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
1205 HAUCK DR, ROLLA, MO 65401-4900
(573) 426-2225
(573) 426-2290
Mailing address
12661 COUNTY ROAD 5050, ROLLA, MO 65401-8053
(573) 578-6416

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2003008892
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
176200
BLUE CROSS BLUE SHIELD
MO
01
694831
HEALTHLINK
MO
Enumeration date
11/28/2006
Last updated
12/02/2016
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