Individual provider Active NPI

Daniel S Peterson, D.C.

  • Chiropractor
  • Saint Paul, MN
National Provider Identifier
1740360718
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4081MNDC Issued in MN
Practice address
2516 7TH Ave E
Saint Paul, MN 55109-3003
Phone
(651) 770-3805
Fax
(651) 747-8737
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4081MNDC MN Primary

Addresses

Primary practice location

2516 7TH Ave E
Saint Paul, MN 55109-3003

Mailing address

2516 7TH Ave E
Saint Paul, MN 55109-3003
Phone (651) 770-3805

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120206000101 MN Practitioner - Chiropractic 1850558776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North St Paul Chiropractic Office, P.a.Group PAC ID 7315995578, 3 clinicians

Practice addresses (Care Compare)

2516 - 7TH Ave E
North Saint Paul, MN 55109-3003
Phone (651) 770-3805

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4081MNMDMarriage & Family Therapist
4081MNDCMNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
North St Paul Chiropractic Office, P.a. Chiropractor CurrentSince Jan 1, 2007 Accepting new patients

Locations

2516 7th Ave E
Saint Paul, MN 55109
Phone (651) 770-3805

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.

NPI Registry JSON

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": "1740360718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 7TH AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551093003",
            "telephone_number": "651-770-3805",
            "fax_number": "651-747-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 7TH AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551093003",
            "telephone_number": "651-770-3805",
            "fax_number": "651-747-8737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DANIEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "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": "MN",
            "license": "4081MNDC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

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.
  • 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.