Provider Demographics
NPI:1841225679
Name:PETERSON, ERIK D (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:D
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 1:2706 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4100
Mailing Address - Country:US
Mailing Address - Phone:815-535-9900
Mailing Address - Fax:
Practice Address - Street 1:3917 E LINCOLNWAY STE B
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9740
Practice Address - Country:US
Practice Address - Phone:815-535-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV03258Medicare UPIN
ILK36667Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER