Diane M Peterson, DC – Chiropractor in Rolla, MO

Key facts

NPI: 1508932062
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: 2003008890 (MO)
Practice address: 1205 Hauck Dr
Rolla, MO 65401-4900
Phone: (573) 426-2225
Fax: (573) 426-2290
NPI assigned: Nov 28, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Peterson Family Chiropractic and Wellness Center Chiropractor · Rolla, MO · NPI 1336215896

NPD (past) Authorized official CHIROPRACTOR

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Peterson Family Chiropractic and Wellness Center	Chiropractor	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	2003008890	MO	Yes

Addresses

Primary practice location

1205 Hauck Dr
Rolla, MO 65401-4900

Mailing address

1312 Woodlawn Dr
Rolla, MO 65401-2521
Phone (573) 426-3418

Other identifiers

Identifier	Type	State	Issuer
660783	Other	MO	UNITED HEALTHCARE
182589	Other	MO	BLUE CROSS BLUE SHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508932062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 WOODLAWN DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012521",
            "telephone_number": "573-426-3418",
            "fax_number": "573-426-2290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 HAUCK DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014900",
            "telephone_number": "573-426-2225",
            "fax_number": "573-426-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2003008890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "660783",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "182589",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

All providers in Rolla, MO · Chiropractor in Missouri

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.