Provider Demographics
NPI:1033825302
Name:PETERKA, ANDREJ CHRISTOPHER (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREJ
Middle Name:CHRISTOPHER
Last Name:PETERKA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WHALAN
Mailing Address - State:MN
Mailing Address - Zip Code:55949-8019
Mailing Address - Country:US
Mailing Address - Phone:612-532-1058
Mailing Address - Fax:
Practice Address - Street 1:313 3RD AVE
Practice Address - Street 2:
Practice Address - City:WHALAN
Practice Address - State:MN
Practice Address - Zip Code:55949-8019
Practice Address - Country:US
Practice Address - Phone:612-532-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist