Tyler James Peterson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6136 Issued in MN

Practice address

8470 City Centre Dr Ste D
Woodbury, MN 55125-3356

Phone

(651) 571-0726

NPI assigned

Feb 2, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 2015

Medicare assignment

May accept Medicare assignment

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.

• Cornerstone Chiropractic Clinic LLC

  • Chiropractor
  • Woodbury, MN
  • NPI 1437518123
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1780042036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8470 CITY CENTRE DR STE D",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253356",
            "telephone_number": "651-571-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8470 CITY CENTRE DR STE D",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253356",
            "telephone_number": "651-571-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TYLER",
        "middle_name": "JAMES",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-02",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Peterson
• Jerome R Peterson, MD
• Michele L Peterson, MD
• Nathan Daniel Peterson, PA-C
• Ramsey Evan Peterson, MD
• Amanda Jo Petri, M.A.
• Stacey S Petric, ATC
• Denise J Petrich
• Jordan Petryniec
• Pamela Jean Pfromm

• Chiropractor in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.