Provider Demographics
NPI:1154301406
Name:PETERSON, JAMES F (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1829
Mailing Address - Country:US
Mailing Address - Phone:906-483-0371
Mailing Address - Fax:
Practice Address - Street 1:424 QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1829
Practice Address - Country:US
Practice Address - Phone:906-483-0371
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C15004OtherBLUE CROSS/BLUE SHIELD
MI0M93250Medicare ID - Type Unspecified