Glen Allen Peterson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3728 Issued in NC

Practice address

817 N Smithfield Rd
Knightdale, NC 27545-7717

Phone

(919) 217-8188

Fax

(919) 217-8189

NPI assigned

Jul 6, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Midtown Chiropractic Clinic PLLC

  • Chiropractor
  • Raleigh, NC
  • NPI 1073303962
  NPD (past)
• Vardy Chiropractic and Wellness Clinics

  dba Wendell Family Chiropractic

  • Chiropractor
  • Wendell, NC
  • NPI 1366525149
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415923200000",
    "number": "1063444776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 N SMITHFIELD RD",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457717",
            "telephone_number": "919-217-8188",
            "fax_number": "919-217-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 N SMITHFIELD RD",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457717",
            "telephone_number": "919-217-8188",
            "fax_number": "919-217-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "GLEN",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2014-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907457",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zenith Patel, P.T
• Mark Paul Pcolinsky, DMD
• Tamika Pegues, DPT
• Hunter Braswell Perry, DMD
• Danielle Peruso
• Phenomenal Home Care LLC
• Jennifer B. Phifer, MD
• Katie Phillips
• Physician Services, P.C. (Knightdale Family Medicine)
• Dustin R. Pierson, D.O.

• Chiropractor in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; 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.