Provider Demographics
NPI:1508269556
Name:HALVORSON, PETER (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HALVORSON
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 1:12792 W ALAMEDA PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2846
Mailing Address - Country:US
Mailing Address - Phone:303-953-5200
Mailing Address - Fax:303-593-7454
Practice Address - Street 1:12792 W ALAMEDA PKWY STE E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2846
Practice Address - Country:US
Practice Address - Phone:303-953-5200
Practice Address - Fax:303-593-7454
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor