Individual provider Active NPI

Christopher Jay Petersen, D.C.

  • Chiropractor
  • Palmdale, CA
National Provider Identifier
1033320346
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC-30197 Issued in CA
Practice address
839 W Palmdale Blvd
Palmdale, CA 93551-4261
Phone
(661) 947-7993
NPI assigned
May 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC-30197 CA Primary

Addresses

Primary practice location

839 W Palmdale Blvd
Palmdale, CA 93551-4261

Mailing address

839 W Palmdale Blvd
Palmdale, CA 93551-4261
Phone (661) 947-7993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405000307 CA Practitioner - Chiropractic 8325222052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

839 W Palmdale Blvd
Palmdale, CA 93551-4261
Phone (661) 947-7993

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC-30197CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Christopher J. Petersen, D.C. Chiropractic, Inc. Chiropractor CurrentSince Dec 14, 2015 Accepting new patients

Locations

839 W Palmdale Blvd
Palmdale, CA 93551
Phone (661) 538-0819

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033320346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 W PALMDALE BLVD",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935514261",
            "telephone_number": "661-947-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 W PALMDALE BLVD",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935514261",
            "telephone_number": "661-947-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CHRISTOPHER",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC-30197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.