Peterson Health Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

248.000537 Issued in IL

Legal business name

PETERSON HEALTH CLINIC LLC

Practice address

815 Lincoln Highway
Suite 109
Fairview Heights, IL 62208

Phone

(618) 589-3911

Fax

(618) 589-3912

NPI assigned

Jan 6, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Ronald G Peterson Jr., D.C.NPI 1891064226

Title

Owner/Physician

Phone

(618) 589-3911

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Ronald Gene Peterson Jr., D.C.

  • Chiropractor
  • Fairview Heights, IL
  • NPI 1891064226
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450137600000",
    "number": "1376813378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 LINCOLN HIGHWAY",
            "address_2": "SUITE 109",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "62208",
            "telephone_number": "618-589-3911",
            "fax_number": "618-589-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 LINCOLN HIGHWAY",
            "address_2": "SUITE 109",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "62208",
            "telephone_number": "618-589-3911",
            "fax_number": "618-589-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON HEALTH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-06",
        "last_updated": "2015-12-15",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "618-589-3911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "248.000537",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012069",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ty Parker, DMD
• Takiera S Parnell
• Federico Parola, M.ED, M.A.
• Caitlyn Patalas, M.S., CCC-SLP
• Pearle Vision Inc (Pearle Vision #C6672)
• Hannah Peterson, BT
• Ronald Gene Peterson Jr., D.C.
• Isabella Pfeiffer
• Madison Phillips
• Ronald Pizzo, O.D.

• Chiropractor in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.