Active NPI
Nickalos Lee Peterson, D.C.
- Chiropractor
- Ridgefield, CT
National Provider Identifier
1598864282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 180
- Practice address
- 31 Bailey Ave
Ridgefield, CT 06877-4533 - Phone
- (203) 438-9609
- Fax
- (203) 438-7141
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 180 | CT | Primary |
Addresses
Primary practice location
31 Bailey Ave
Ridgefield, CT 06877-4533
Mailing address
31 Bailey Ave
Ridgefield, CT 06877-4533
Phone (203) 438-9609
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P405105 | Other | CT | OXFORD PROVIDER ID NUMBER |
| 4380815 | Other | CT | AETNA PPO ID NUMBER |
| 050000180CT01 | Other | CT | ANTHEM BC/BS ID PROVIDER |
| LANDMARK /HEALTH NET | Other | CT | CT00180 PROVIDER ID# |
| 9323280003 | Other | CT | CIGNA PROVIDER ID NUMBER |
| 0114667 | Other | CT | AETNA HMO ID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598864282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 BAILEY AVE",
"city": "RIDGEFIELD",
"state": "CT",
"postal_code": "068774533",
"telephone_number": "203-438-9609",
"fax_number": "203-438-7141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 BAILEY AVE",
"city": "RIDGEFIELD",
"state": "CT",
"postal_code": "068774533",
"telephone_number": "203-438-9609",
"fax_number": "203-438-7141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "NICKALOS",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CT",
"license": "180",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD PROVIDER ID NUMBER",
"identifier": "P405105",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO ID NUMBER",
"identifier": "4380815",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS ID PROVIDER",
"identifier": "050000180CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CT00180 PROVIDER ID#",
"identifier": "LANDMARK /HEALTH NET",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER ID NUMBER",
"identifier": "9323280003",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO ID NUMBER",
"identifier": "0114667",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgefield, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.