Jesse Peterson, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1333 Issued in MN

Practice address

2151 Hamline Ave N Ste 108
Roseville, MN 55113-4226

Phone

(612) 242-9630

NPI assigned

Mar 29, 2007

Last updated

Mar 31, 2011By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eastern Health Inc

  • Acupuncturist
  • Roseville, MN
  • NPI 1265552962
  NPD (past) Authorized official

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1235259946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 HAMLINE AVE N",
            "address_2": "SUITE 108",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134236",
            "telephone_number": "612-242-9630",
            "fax_number": "651-636-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 HAMLINE AVE N STE 108",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551134226",
            "telephone_number": "612-242-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JESSE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "1333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael James Petersen, D.D.S.
• Alyssa Marie Peterson, L.AC.
• Annika Peterson, APRN, CNP
• Gloria J Peterson, MD
• Janelle Peterson
• Hannah Kristine Petterson, PA-C
• Lindsey Nicole Pham, PA-C
• Gregory Phelan, M.D
• Jeffrey S Phelan, MD
• Jonathan Allen Phelan, D.O.

• Acupuncturist in Roseville, MN
• Providers in Roseville, MN by specialty
• Acupuncturist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; 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.