Provider Demographics
NPI:1972943215
Name:PETERSON, GARRETT QUINN (DC)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:QUINN
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 1:3300 RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING C SUITE 200
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-893-1010
Mailing Address - Fax:
Practice Address - Street 1:3300 RUNNING CREEK WAY
Practice Address - Street 2:BUILDING C SUITE 200
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-893-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8604137-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor