Anicia Gwen Peterson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3138 Issued in MN

Practice address

13743 E Shore Rd
Crosslake, MN 56442-4033

Phone

(218) 692-1616

Fax

(218) 692-1626

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwoods Chiropractic P. a.

  • Chiropractor
  • Crosslake, MN
  • NPI 1477610194
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003973702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13743 E SHORE RD",
            "city": "CROSSLAKE",
            "state": "MN",
            "postal_code": "564424033",
            "telephone_number": "218-692-1616",
            "fax_number": "218-692-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13743 E SHORE RD",
            "city": "CROSSLAKE",
            "state": "MN",
            "postal_code": "564424033",
            "telephone_number": "218-692-1616",
            "fax_number": "218-692-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANICIA",
        "middle_name": "GWEN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OFFICE ID #",
            "identifier": "68D24NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL ID #",
            "identifier": "68D25PE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Lewis, DDS
• Sannah Lohmiller
• Sara Marie Lokstad, M.D.
• Naomi Nelson, MS, LPCC
• Northwoods Chiropractic P. a.
• Adrienne Milligan Platt, CPNP
• Courtney Regnier, LMFT
• Naomi Rae Roepke, CNP
• Senior Care Consulting, LLC
• Loren Arnold Smeby, M.D.

• Chiropractor in Crosslake, MN
• Providers in Crosslake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.