Timothy J Peters, D.C.
Individual provider Active NPI Chiropractor · Dickinson, ND
NPI 1124137955 · NPPES record last updated Dec 1, 2008
Key facts
- NPI
- 1124137955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 564 (ND)
- Practice address
- 562 12TH St W
Dickinson, ND 58601-3509 - Phone
- (701) 483-1104
- Fax
- (701) 483-1443
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080314000056 | ND | Practitioner - Chiropractic | 9830274851 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 564 | ND | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peters Chiropractic, P.C. | Chiropractor | Current |
Accepting new patients |
Locations
562 12th St W
Dickinson, ND 58601
Phone (701) 483-1104
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 564 | ND | Yes |
Addresses
Primary practice location
562 12TH St W
Dickinson, ND 58601-3509
Mailing address
562 W 12TH
Dickinson, ND 58601-3509
Phone (701) 483-1104
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17920 | Medicaid | ND | |
| 12125 | Other | ND | BLUE CROSS BLUE SHIELD |
Other providers in Dickinson, ND
- Jessica Lynn Perry
- Janiece Pessoa
- Peters Chiropractic, P.C.
- Haylee Peters
- Thomas James Peters
- Braydon D Peterson
- Brody William Peterson
- Gary D Peterson
- Kami L Peterson
- Shantelle Lace Petroff
All providers in Dickinson, ND · Chiropractor in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.