John Robert Petersen, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4232 Issued in MN

Practice address

2216 County Road D W
Saint Paul, MN 55112-7500

Phone

(651) 639-1066

Fax

(651) 639-1069

NPI assigned

Apr 23, 2007

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228262400000",
    "number": "1497973630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 COUNTY ROAD D W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551127500",
            "telephone_number": "651-639-1066",
            "fax_number": "651-639-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2216 COUNTY ROAD D W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551127500",
            "telephone_number": "651-639-1066",
            "fax_number": "651-639-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2008-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HSM PREFERRED ONE",
            "identifier": "411508205",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65M40PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "906459100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Lee Petersen Morehead, PHYSICAL THERAPY
• Amanda Petersen-Hayes
• Rachel L Petersen-Nguyen, MD
• Clairessa Elaine Petersen
• Haley Petersen
• Karl John Petersen, DDS
• Katherine A Petersen, C.N.P.
• Linda Louise Petersen, RN, BSN
• Mitchell Petersen
• Peterson & Peterson DDS PA

• Chiropractor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; 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.