Active NPI
Jason D Peterson, D.C.
- Chiropractor
- Willmar, MN
National Provider Identifier
1992825244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3352
- Practice address
- 700 1St St S
Willmar, MN 56201-3504 - Phone
- (320) 231-1414
- Fax
- (320) 231-2828
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3352 | MN | Primary |
Addresses
Primary practice location
700 1St St S
Willmar, MN 56201-3504
Mailing address
700 1St St S
Willmar, MN 56201-3504
Phone (320) 231-1414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31B85PE | Other | MN | BLUECROSSBLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3352 | MN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Health-Paynesville LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Medicare Defined Swing Bed Hospital Unit
- Paynesville, MN
- NPI 1457786972
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992825244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 1ST ST S",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562013504",
"telephone_number": "320-231-1414",
"fax_number": "320-231-2828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 1ST ST S",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562013504",
"telephone_number": "320-231-1414",
"fax_number": "320-231-2828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JASON",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3352",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "31B85PE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
- Jennifer A Pesola, DO
- Lois Ann Peters, BSN, RN, PHN, CLC
- Rebecca Jean Petersen, LPN PE
- Brett Wayne Peterson, D.C.
- Eric Julian Peterson, CRNA,MSN
- Melissa Ann Peterson, LPCC
- Timothy R Pieh, MD
- Joshua Allen Pierskalla, LMFT
- Planned Parenthood Minnesota, North Dakota, South Dakota
- James Douglas Pohl, CNP, PMHNP, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.