Provider Demographics
NPI:1427302355
Name:SUZANNE PETERSEN CHIROPRACTIC
Entity type:Organization
Organization Name:SUZANNE PETERSEN CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-624-2500
Mailing Address - Street 1:2351 SUNSET BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:916-624-4196
Practice Address - Street 1:2351 SUNSET BLVD
Practice Address - Street 2:STE 120
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4338
Practice Address - Country:US
Practice Address - Phone:916-624-2500
Practice Address - Fax:916-624-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty