Petersen Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

623 Issued in WY

Legal business name

PETERSEN CHIROPRACTIC LLC

Practice address

3805 S Douglas Hwy
Unit # 2
Gillette, WY 82718-6554

Phone

(307) 686-0303

Fax

(307) 686-2882

NPI assigned

Aug 23, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Clinton Jerome Petersen, D.C.NPI 1770521221

Title

Doctor/Owner

Phone

(307) 686-0303

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clinton Jerome Petersen, D.C.

  • Chiropractor
  • Gillette, WY
  • NPI 1770521221
  NPD (past) Authorized official

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1023324597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 S DOUGLAS HWY",
            "address_2": "UNIT # 2",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186554",
            "telephone_number": "307-686-0303",
            "fax_number": "307-686-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 S DOUGLAS HWY",
            "address_2": "UNIT # 2",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186554",
            "telephone_number": "307-686-0303",
            "fax_number": "307-686-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-23",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "307-686-0303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WY",
            "license": "623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Perry, NRP
• Kelsey Persian
• Personal Frontiers, Inc.
• Kelly Peters
• Roxanne Leigh Peters, PA-C
• Chelsey Nicole Petersen, MSN RN
• Clinton Jerome Petersen, D.C.
• Judeth Petersen, M.A., LPC
• Byron James Peterson
• Jeannie C Peterson

• Chiropractor in Gillette, WY
• Providers in Gillette, WY by specialty
• Chiropractor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.