Jennifer Jill Petersen, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3661 Issued in MN

Practice address

20730 Holyoke Ave
Suite 34
Lakeville, MN 55044

Phone

(952) 469-6016

Fax

(952) 469-4017

NPI assigned

Dec 15, 2006

Sex

Female

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

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124180104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 154",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550440154",
            "telephone_number": "952-469-6016",
            "fax_number": "952-469-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20730 HOLYOKE AVE",
            "address_2": "SUITE 34",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "55044",
            "telephone_number": "952-469-6016",
            "fax_number": "952-469-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JENNIFER",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelika Permuth
• Andrew Raymond Peroutky, RCP RRT CRTT
• Kaetherine Perry, RDH
• Suzanne Marie Peters, MA CCC-SLP
• Petersen Family Dental Clinic PA
• Steven Blaine Petersen, DDS
• Ali Elizabeth Peterson, MD
• Jenilee Elizabeth Peterson
• Latasha Peterson, M.A., LPCC
• Chelsea L Petrich, PHARM.D.

• Chiropractor in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Chiropractor in Minnesota

• 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.