Provider Demographics
NPI:1689849531
Name:LAURA PETERSON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LAURA PETERSON CHIROPRACTIC, INC.
Other - Org Name:FAMILY HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-355-0440
Mailing Address - Street 1:24988 BLUE RAVINE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5284
Mailing Address - Country:US
Mailing Address - Phone:916-355-0440
Mailing Address - Fax:916-355-0441
Practice Address - Street 1:24988 BLUE RAVINE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5284
Practice Address - Country:US
Practice Address - Phone:916-355-0440
Practice Address - Fax:916-355-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26751ZMedicare PIN