Provider Demographics
NPI:1790870160
Name:PETERSON, ELIZABETH PORTER (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:PORTER
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:PORTER
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:26 MADISON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-773-9248
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y45164Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER