Provider Demographics
NPI:1285973107
Name:PETERSON, WILLIAM WINSTON LEONARD III (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WINSTON LEONARD
Last Name:PETERSON
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:WL
Other - Last Name:PETERSON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1700 SE HILLMOOR DR
Mailing Address - Street 2:STE 502
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7566
Mailing Address - Country:US
Mailing Address - Phone:772-783-3472
Mailing Address - Fax:
Practice Address - Street 1:1700 SE HILLMOOR DR
Practice Address - Street 2:STE 502
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7566
Practice Address - Country:US
Practice Address - Phone:772-333-2648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor