Provider Demographics
NPI:1346303617
Name:PETERSON, MARILYN KATHLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:KATHLEEN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 PARKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4403
Mailing Address - Country:US
Mailing Address - Phone:678-344-6821
Mailing Address - Fax:770-985-8758
Practice Address - Street 1:2519 PARKWOOD RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4403
Practice Address - Country:US
Practice Address - Phone:678-344-6821
Practice Address - Fax:770-985-8758
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor