Kelsey Carl Peterson Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G17592 Issued in CA

Practice address

17742 Beach Blvd
245
Huntington Beach, CA 92647-6818

Phone

(714) 329-0179

Fax

(714) 965-0311

NPI assigned

Nov 14, 2006

Last updated

Mar 15, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458000000000",
    "number": "1033281019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20462 KENWORTH CIR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926465446",
            "telephone_number": "714-329-0179",
            "fax_number": "714-965-0311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17742 BEACH BLVD",
            "address_2": "245",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476818",
            "telephone_number": "714-329-0179",
            "fax_number": "714-965-0311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KELSEY",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2016-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G17592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peters Chiropractic Corporation
• Steven Matthew Peters, D.C.
• Eugene J. Peterson, PT
• Hunter Haylee Peterson
• Kelly Rose Peterson, DPT
• Laura Hayden Peterson
• Monique Peterson, P.T.
• Chanel Dyan Petrasek
• Cameron Pettine de-Ru
• Kamila Pettit

• Specialist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; 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.