NPIMap

Organization Active NPI

Peterson Wellness Clinic P.a.

Doing business as Green Lake Chiropractic Center

  • Chiropractor
  • Spicer, MN
National Provider Identifier
1639791932
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PETERSON WELLNESS CLINIC P.A.
Doing business as
Green Lake Chiropractic Center
Practice address
194 Progress Way
Spicer, MN 56288-5000
Phone
(320) 583-5839
NPI assigned
May 11, 2020
Last updated
May 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Zachary Leland Peterson, DCNPI 1083236384
Title
Chiropractor
Phone
(320) 583-5839

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

194 Progress Way
Spicer, MN 56288-5000

Mailing address

194 Progress Way
Spicer, MN 56288-5000
Phone (320) 583-5839

Other names 1

  • Green Lake Chiropractic Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200527000174 MN Part B Supplier - Clinic/Group Practice 7113348368 Receives reassigned benefits from 2 practitioners
Practice locations: Spicer, MN

National Provider Directory

National Provider Directory

Locations

120 W South St
Spicer, MN 56288
Phone (320) 409-1441

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1639791932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 PROGRESS WAY",
            "city": "SPICER",
            "state": "MN",
            "postal_code": "562885000",
            "telephone_number": "320-583-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 PROGRESS WAY",
            "city": "SPICER",
            "state": "MN",
            "postal_code": "562885000",
            "telephone_number": "320-583-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON WELLNESS CLINIC P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "LELAND",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "320-583-5839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Lake Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spicer, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.