Provider Demographics
NPI:1891139135
Name:PETERSEN, CLAIRE BARBARA (DC)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:BARBARA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:STE B1
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4975
Mailing Address - Country:US
Mailing Address - Phone:315-452-9420
Mailing Address - Fax:315-452-9132
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2097
Practice Address - Country:US
Practice Address - Phone:607-256-9355
Practice Address - Fax:607-275-9355
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor