Gregory Joseph Petersen, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5767 Issued in MN

Practice address

9505 Blackoaks LN N
Maple Grove, MN 55311-1229

Phone

(763) 420-4111

Fax

(763) 420-4145

NPI assigned

Feb 27, 2013

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

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Petersen Chiropractic Inc.

  • Chiropractor
  • Maple Grove, MN
  • NPI 1144634395
  Medicare reassignment

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1851631907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 BLACKOAKS LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111229",
            "telephone_number": "763-420-4111",
            "fax_number": "763-420-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 BLACKOAKS LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111229",
            "telephone_number": "763-420-4111",
            "fax_number": "763-420-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GREGORY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Persevere Wellness LLC
• Pery Home Care LLC
• Beth Ann Pesta, PT
• Laura Linn Peters, LPCC
• Petersen Chiropractic Inc.
• John William Petersen, D.C.
• Stephanie Jean Petersen, PHARM.D.
• Peterson Counseling and Consulting LLC
• Beth K. Peterson, MSW, LICSW
• Colleen Ann Peterson, RN

• Chiropractor in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.