Robert Todd Petersen, DC, OPAC, ATC, LAT

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

9289 Issued in TX

Practice address

3408 Milton Ave
Dallas, TX 75205-1338

Phone

(214) 739-2225

Fax

(214) 739-2228

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Park Cities Chirosport Inc

  • Rehabilitation Chiropractor
  • Dallas, TX
  • NPI 1114160827
  Medicare reassignment NPD
• Sports and Spine Therapy, Inc.

  • Sports Physician Chiropractor
  • Dallas, TX
  • NPI 1033316039
  NPD (past) Authorized official

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1811917172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 MILTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752051338",
            "telephone_number": "214-739-2225",
            "fax_number": "214-739-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 MILTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752051338",
            "telephone_number": "214-739-2225",
            "fax_number": "214-739-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "ROBERT",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "DC, OPAC, ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "TX",
            "license": "9289",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "UT",
            "license": "5118449-1202",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID NUMBER",
            "identifier": "607194",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Peters
• Walter Russell Peters Jr., M.D., M.B.A
• Henry Petersen
• Katharine Petersen, M.D.
• Katherine Petersen, MD
• Blair Shackleton Peterson, PA-C
• Brittany Alese Peterson, FNP-C
• Christina Peterson, RN
• Clifton Peterson
• Eric Peterson, M.D.

• Sports Physician Chiropractor in Dallas, TX
• Providers in Dallas, TX by specialty
• Sports Physician Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.