Keith A Peterson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2003008892 Issued in MO

Practice address

1205 Hauck Dr
Rolla, MO 65401-4900

Phone

(573) 426-2225

Fax

(573) 426-2290

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

No

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.

• Peterson Family Chiropractic and Wellness Center

  • Chiropractor
  • Rolla, MO
  • NPI 1336215896
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 2, 2016.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1972679439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12661 COUNTY ROAD 5050",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654018053",
            "telephone_number": "573-578-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 HAUCK DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014900",
            "telephone_number": "573-426-2225",
            "fax_number": "573-426-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2003008892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "176200",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "694831",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Pearson, DPM
• Jenny L Pennycook, M.D.
• Gregory Pernoud, DDS
• Peterson Family Chiropractic and Wellness Center
• Diane M Peterson, DC
• PG Optical LLC
• Phelps County Clerk
• Phelps County Industrial Solutions Inc
• Phelps County Regional Medical Center
• Phelps County Regional Medical Center

• All providers in Rolla, MO
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.