NPIMap

Organization Active NPI

Timothy D Petersen Chiropractic Inc.

  • Chiropractor
  • Rocklin, CA
National Provider Identifier
1366722142
Registry record updated Aug 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
21088 Issued in CA
Legal business name
TIMOTHY D PETERSEN CHIROPRACTIC INC.
Practice address
2351 Sunset Blvd Ste 120
Rocklin, CA 95765-4341
Phone
(916) 624-2500
Fax
(916) 624-4196
NPI assigned
Aug 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2011

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

Authorized official

Name
Dr. Timothy Dee Petersen, D.C.
Title
President
Phone
(916) 625-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 21088 CA Primary

Addresses

Primary practice location

2351 Sunset Blvd Ste 120
Rocklin, CA 95765-4341

Mailing address

2351 Sunset Blvd Ste 120
Rocklin, CA 95765-4341
Phone (916) 624-2500

Other identifiers 2

IdentifierTypeStateIssuer
DC0210880OtherCAMEDICARE PROVIDER NUMBER
1891853453OtherCANPI NUMBER

Other names 1

  • Stanford Ranch Chiropractic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1366722142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 SUNSET BLVD STE 120",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654341",
            "telephone_number": "916-624-2500",
            "fax_number": "916-624-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 SUNSET BLVD STE 120",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654341",
            "telephone_number": "916-624-2500",
            "fax_number": "916-624-4196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY D PETERSEN CHIROPRACTIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-625-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "21088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "DC0210880",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1891853453",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stanford Ranch Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocklin, CA

Sources for this page

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