Provider Demographics
NPI:1710510896
Name:DOC'S BODY SHOP, PLLC
Entity Type:Organization
Organization Name:DOC'S BODY SHOP, PLLC
Other - Org Name:OFFICE OF DR. REESE R. PETERSEN, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REESE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-259-6173
Mailing Address - Street 1:2418 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-6827
Mailing Address - Country:US
Mailing Address - Phone:563-259-6173
Mailing Address - Fax:
Practice Address - Street 1:2418 S 18TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-6827
Practice Address - Country:US
Practice Address - Phone:563-259-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty