Peterson Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PETERSON CHIROPRACTIC CENTER

Practice address

2599 White Bear Ave N
Maplewood, MN 55109-5171

Phone

(651) 779-8115

Fax

(651) 779-9319

NPI assigned

Feb 9, 2007

Last updated

Jan 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Thomas Douglass-White, DCNPI 1255861985

Title

President

Phone

(651) 779-8115

Specialties & licenses 2

Addresses

Other names 1

• ProAdjuster Chiropractic Center Former legal business name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Thomas Douglass-White, D.C.

  • Chiropractor
  • Maplewood, MN
  • NPI 1255861985
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1437290871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2599 WHITE BEAR AVE N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2599 WHITE BEAR AVE N",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095171",
            "telephone_number": "651-779-8115",
            "fax_number": "651-779-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS-WHITE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-779-8115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2446",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProAdjuster Chiropractic Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "ProAdjuster Chiropractic Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Amanda Jo Perkins, PHARM D.
• Carron Perry, D.C.
• Erica A Perry, CRNA
• Tina Perry
• Peter H Mielke DDS Pediatric Dentistry
• Andrew Frederick Peterson
• Bruce Allen Peterson, DC
• Dana Alexandra Peterson, APRN
• Andrzej Petryk, M.D.
• Duc The Pham, PHARMD, RPH

• Chiropractor in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.