Corey Peterson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC36259 Issued in CA

Practice address

3186 Airway Ave Ste J
Costa Mesa, CA 92626-4650

Phone

(657) 418-6702

NPI assigned

Mar 1, 2022

Last updated

Feb 24, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708732800000",
    "number": "1801542774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 NEWPORT BLVD APT L102",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926276533",
            "telephone_number": "831-566-9681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3186 AIRWAY AVE STE J",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264650",
            "telephone_number": "657-418-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "COREY",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-01",
        "last_updated": "2024-02-24",
        "certification_date": "2024-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC36259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Pesonen
• Scott Thomas Pestotnik, PHARM D
• Tonya Lynn Peters-Kammeraad, L.C.S.W., NCPSYA
• Stacy Anne Petersen, FNP-C
• Susan Petersen, M.P.T
• Emily Pettis, APRN
• Paul Ceif Petty, D.C.
• Marjorie Ann Pezzoli
• Ann Pham
• Connie Pham, DO

• Chiropractor in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.