Provider Demographics
NPI:1487437364
Name:PETERSON, CHRISTOPHER QUINTON (MS, RDN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:QUINTON
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 S BLACKHAWK ST APT 7201
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4092
Mailing Address - Country:US
Mailing Address - Phone:720-375-2717
Mailing Address - Fax:
Practice Address - Street 1:7550 S BLACKHAWK ST APT 7201
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4092
Practice Address - Country:US
Practice Address - Phone:720-375-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86153905133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered