Provider Demographics
NPI:1659592533
Name:PETTERSSON, HOWARD ALFRED (DC)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ALFRED
Last Name:PETTERSSON
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:PO BOX 2686
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-2686
Mailing Address - Country:US
Mailing Address - Phone:563-285-4434
Mailing Address - Fax:
Practice Address - Street 1:8 JACOB DR
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-9581
Practice Address - Country:US
Practice Address - Phone:563-285-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA #04856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11177Medicare ID - Type Unspecified
IAT01247Medicare UPIN