Active NPI
Broderick Alan Peterson, D.C.
- Chiropractor
- Hopkins, MN
National Provider Identifier
1245508720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5821
- Practice address
- 15 8TH Ave N
Hopkins, MN 55343-7611 - Phone
- (303) 827-8490
- NPI assigned
- Dec 12, 2011
- Last updated
- Sep 24, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6786 | CO | |
| Chiropractor | 111N00000X | 5821 | MN | Primary |
Addresses
Primary practice location
15 8TH Ave N
Hopkins, MN 55343-7611
Mailing address
15 8TH Ave N
Hopkins, MN 55343-7611
Phone (303) 827-8490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
15 8TH Ave N
Hopkins, MN 55343-7611
Phone (952) 933-5085
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6786 | CO | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DMR Methods | Chiropractor | Current | Accepting new patients |
Locations
15 8th Ave N
Ste 2
Hopkins, MN 55343
Phone (952) 207-2768
Organizations & group practices 2
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.
-
dba DMR Clinic Woodbury
- Chiropractor
- Hopkins, MN
- NPI 1396932067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379980800000",
"number": "1245508720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 8TH AVE N",
"city": "HOPKINS",
"state": "MN",
"postal_code": "553437611",
"telephone_number": "303-827-8490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 8TH AVE N",
"city": "HOPKINS",
"state": "MN",
"postal_code": "553437611",
"telephone_number": "303-827-8490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "BRODERICK",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-12",
"last_updated": "2013-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CO",
"license": "6786",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "5821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hopkins, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.