Petersen Chiropractic Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1764 Issued in MN

Legal business name

PETERSEN CHIROPRACTIC INC.

Practice address

9505 Blackoaks LN No.
Maple Grove, MN 55311

Phone

(763) 420-4111

Fax

(763) 420-4145

NPI assigned

Jun 16, 2014

Organization subpart

No

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

Authorized official

Name

Dr. John William Petersen, D.C.

Title

Chiropractor

Phone

(763) 420-4111

Specialties & licenses 2

Addresses

Other names 1

• North Maple Grove Chiropractic Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Joseph Petersen, D.C.

  • Chiropractor
  • Maple Grove, MN
  • NPI 1851631907
  Medicare reassignment

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1144634395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 BLACKOAKS LN NO",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55311",
            "telephone_number": "763-420-4111",
            "fax_number": "763-420-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 BLACKOAKS LN NO.",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55311",
            "telephone_number": "763-420-4111",
            "fax_number": "763-420-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN CHIROPRACTIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "763-420-4111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1764",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5767",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Maple Grove Chiropractic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nina Rachel Perdue, M.D.
• Persevere Wellness LLC
• Pery Home Care LLC
• Beth Ann Pesta, PT
• Laura Linn Peters, LPCC
• Gregory Joseph Petersen, D.C.
• John William Petersen, D.C.
• Stephanie Jean Petersen, PHARM.D.
• Peterson Counseling and Consulting LLC
• Beth K. Peterson, MSW, LICSW

• Chiropractor in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.