Dr. Tim Peterson, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7180 Issued in TX

Legal business name

DR. TIM PETERSON, PLLC

Practice address

4230 Gardendale St Ste 201
San Antonio, TX 78229-3476

Phone

(210) 691-2747

Fax

(210) 691-2872

NPI assigned

Jun 29, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Ward Peterson, DCNPI 1548312382

Title

Owner

Phone

(210) 691-2747

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Peterson Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy W. Peterson, D.C.

  • Chiropractor
  • San Antonio, TX
  • NPI 1548312382
  Medicare reassignment Care Compare group NPD Authorized official
• McKenzie Slattery, DC

  • Chiropractor
  • San Antonio, TX
  • NPI 1053168567
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530230400000",
    "number": "1902391121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 GARDENDALE ST STE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293476",
            "telephone_number": "210-691-2747",
            "fax_number": "210-691-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 GARDENDALE ST STE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293476",
            "telephone_number": "210-691-2747",
            "fax_number": "210-691-2872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TIM PETERSON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-29",
        "last_updated": "2018-06-29",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-691-2747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "7180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1548312382",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.