Timothy John Peterson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1654 Issued in WI

Practice address

10135 Hwy SS
Bloomer, WI 54724

Phone

(715) 568-1251

Fax

(715) 568-1252

NPI assigned

Oct 16, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1981

Medicare assignment

May accept Medicare assignment

Group practices

Peterson Chiropractic Clinic LTDGroup PAC ID 4587839170, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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 Chiropractic Clinic LTD

  • Chiropractor
  • Bloomer, WI
  • NPI 1982773867
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609956481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10135 HWY SS",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "54724",
            "telephone_number": "715-568-1251",
            "fax_number": "715-568-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10135 HWY SS",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "54724",
            "telephone_number": "715-568-1251",
            "fax_number": "715-568-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "1654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "481291951010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joellen Parkes
• Kelly A Paschke, OT
• Linda B Petersen, PT
• Peterson Chiropractic Clinic LTD
• Ronald Daniel Peterson, DC
• Pharmacare LTD
• Pharmacare LTD
• PHCN, LLC
• Kenadi Veronica Poirier, MS, ATC
• Erin Poynter

• Chiropractor in Bloomer, WI
• Providers in Bloomer, WI by specialty
• Chiropractor in Wisconsin

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.