Provider Demographics
NPI:1083003081
Name:PETERSON, ANN (DC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:615 MAIN ST # 768
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9806
Mailing Address - Country:US
Mailing Address - Phone:231-994-3688
Mailing Address - Fax:
Practice Address - Street 1:615 MAIN ST # 768
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9806
Practice Address - Country:US
Practice Address - Phone:231-994-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010411111N00000X
OH4503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor