John R. Petersen D.C. P.a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4232 Issued in MN

Legal business name

JOHN R. PETERSEN D.C. P.A.

Doing business as

Spine & Sports Chiropractic

Practice address

2216 County Road D W
Saint Paul, MN 55112-7500

Phone

(651) 639-1066

Fax

(651) 630-1069

NPI assigned

Jul 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John Robert Petersen, D.C.

Title

Doctor of Chiropractic

Phone

(651) 639-1066

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spine & Sports Chiropractic Doing business as

Locations

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228262400000",
    "number": "1194922179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 COUNTY ROAD D W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551127500",
            "telephone_number": "651-639-1066",
            "fax_number": "651-630-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 COUNTY ROAD D W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551127500",
            "telephone_number": "651-639-1066",
            "fax_number": "651-630-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R. PETERSEN D.C. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2008-12-03",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "651-639-1066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65M39SP",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spine & Sports Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Elizabeth Johlson
• John E. Savage, M.D., P.a.
• John Hansen M.a. Licensed Psychologist LLC
• John W Benton MD PA
• Paulose S John, M.D
• Christine L Johns, MD
• James W Johns, LICSW
• Erica Lynn Johnsen, PHD, LP

• Chiropractor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.