Provider Demographics
NPI:1447904099
Name:PETERSON CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:PETERSON CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-764-4212
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-0306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-3024
Practice Address - Country:US
Practice Address - Phone:402-764-4212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty