Provider Demographics
NPI:1689669228
Name:PETERSON, DAVID ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:PETERSON
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 1:1143 HILLTOP DR.
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003
Mailing Address - Country:US
Mailing Address - Phone:530-224-1752
Mailing Address - Fax:530-224-1753
Practice Address - Street 1:1143 HILLTOP DR.
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003
Practice Address - Country:US
Practice Address - Phone:530-224-1752
Practice Address - Fax:530-224-1753
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 0221210Medicare ID - Type UnspecifiedPROVIDER #
CAU49661Medicare UPIN