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

Last updated

Dec 3, 2008By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• John R. Petersen D.C. P.a.

  dba Spine & Sports Chiropractic

  • Chiropractor
  • Saint Paul, MN
  • NPI 1194922179
  Authorized official Same address or phone

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": [],
    "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.