Individual
DR. JASON D PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
700 1ST ST S, WILLMAR, MN 56201-3504
(320) 231-1414
(320) 231-2828
Mailing address
700 1ST ST S, WILLMAR, MN 56201-3504
(320) 231-1414
(320) 231-2828
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3352
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31B85PE
BLUECROSSBLUESHIELD
MN
Enumeration date
03/30/2007
Last updated
07/08/2007
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