Provider Demographics
NPI:1679653265
Name:DR. ELIZABETH PETERSON CHIROPRACTIC & NATURAL HEALTH
Entity Type:Organization
Organization Name:DR. ELIZABETH PETERSON CHIROPRACTIC & NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-774-3348
Mailing Address - Street 1:474 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3315
Mailing Address - Country:US
Mailing Address - Phone:413-774-3348
Mailing Address - Fax:413-774-2239
Practice Address - Street 1:474 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3315
Practice Address - Country:US
Practice Address - Phone:413-774-3348
Practice Address - Fax:413-774-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y45535Medicare ID - Type Unspecified
Y45164Medicare ID - Type Unspecified