Provider Demographics
NPI:1659455228
Name:PETERSON, ROBIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:A
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 1:2084 9TH ST
Mailing Address - Street 2:STE. C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3256
Mailing Address - Country:US
Mailing Address - Phone:805-528-4772
Mailing Address - Fax:805-528-4776
Practice Address - Street 1:2084 9TH ST
Practice Address - Street 2:STE. C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3256
Practice Address - Country:US
Practice Address - Phone:805-528-4772
Practice Address - Fax:805-528-4776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15600Medicare ID - Type Unspecified