Russell N Petersen, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4058-012 Issued in WI

Practice address

4027 S Business Dr
Sheboygan, WI 53081-1261

Phone

(920) 459-9090

Fax

(920) 459-7426

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Creekside Chiropractic and Rehabilitation LTDGroup PAC ID 8921029760, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Creekside Chiropractic and Rehabilitation, LTD.

  • Chiropractor
  • Sheboygan, WI
  • NPI 1801076872
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1164550620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4027 S BUSINESS DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811261",
            "telephone_number": "920-459-9090",
            "fax_number": "920-459-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 S BUSINESS DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811261",
            "telephone_number": "920-459-9090",
            "fax_number": "920-459-7426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "RUSSELL",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4058-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38834800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adeel Pervez
• Carolyn Peters, PA-C
• Denise Peters
• John Demi Peters, M.D.
• Anessa Santiago Petersen, NP
• Maddie Peterson, PHARMD
• Stephanie Peterson
• Alyssa Pfeifer-Rentmeester, PA-C
• Brandon Phelps
• Terra Phelps, OTR

• Chiropractor in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; 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.