Kenneth R Peterson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

001702 Issued in CT

Practice address

62 Fort Hill Rd Ste B
Groton, CT 06340-4398

Phone

(860) 440-6754

Fax

(860) 495-0043

NPI assigned

Apr 13, 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

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

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.

• Inner Wisdom Chiropractic, LLC

  • Chiropractor
  • Groton, CT
  • NPI 1932350907
  NPD (past)

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1164646741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 FORT HILL RD",
            "address_2": "STE B",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404398",
            "telephone_number": "860-440-6754",
            "fax_number": "860-440-6757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 FORT HILL RD STE B",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404398",
            "telephone_number": "860-440-6754",
            "fax_number": "860-495-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KENNETH",
        "middle_name": "R",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethzaida Perez Villegas, LMSW
• Christine Perkins, MA
• Lori A Perry, LCSW
• Lydia Prudence Perry, LPC, LADC
• David Andrew Peterson Jr.
• Lauren Pettit, BS
• Kristin Pezzolesi, RDH
• Phalanx Med Connecticut, LLC
• David Phelps Jr., DDS
• Phillips Integrative Health

• Chiropractor in Groton, CT
• Providers in Groton, CT by specialty
• Chiropractor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; 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.