Provider Demographics
NPI:1376549428
Name:PETERSON, MARGARET I (DC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:I
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:207-338-6463
Mailing Address - Fax:207-338-4060
Practice Address - Street 1:29 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6630
Practice Address - Country:US
Practice Address - Phone:207-338-6463
Practice Address - Fax:207-338-4060
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1035111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM23713OtherTRICARE
ME037085OtherBLUE CROSS BLUE SHIELD
MEU74575Medicare UPIN
MEMM7710Medicare ID - Type UnspecifiedMEDICARE