Marypat C Peterson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3133-012 Issued in WI

Practice address

113 Central Ave
Coon Valley, WI 54623-8039

Phone

(608) 452-2525

Fax

(608) 452-2526

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coon Valley Chiropractic SCGroup PAC ID 6901856053, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Coon Valley Chiropractic S.C.

  • Chiropractor
  • Coon Valley, WI
  • NPI 1275610222
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365724800000",
    "number": "1861504896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 CENTRAL AVE",
            "city": "COON VALLEY",
            "state": "WI",
            "postal_code": "546238039",
            "telephone_number": "608-452-2525",
            "fax_number": "608-452-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 CENTRAL AVE",
            "city": "COON VALLEY",
            "state": "WI",
            "postal_code": "546238039",
            "telephone_number": "608-452-2525",
            "fax_number": "608-452-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARYPAT",
        "middle_name": "C",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3133-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38880300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coon Valley Chiropractic S.C.
• Carl R Peterson, D.C.
• Willow Tree Counseling LLC

• Chiropractor in Coon Valley, WI
• Providers in Coon Valley, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.