Provider Demographics
NPI:1821353285
Name:PETERSON, JAMES NC (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NC
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2021 S WAVERLY AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2414
Mailing Address - Country:US
Mailing Address - Phone:417-883-1141
Mailing Address - Fax:417-889-6627
Practice Address - Street 1:2021 S WAVERLY AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2414
Practice Address - Country:US
Practice Address - Phone:417-883-1141
Practice Address - Fax:417-889-6627
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor