Provider Demographics
NPI:1942518402
Name:PETERSEN, KATE E (DC)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:E
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 1:5122 N RHETT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4240
Mailing Address - Country:US
Mailing Address - Phone:843-744-2265
Mailing Address - Fax:843-747-4421
Practice Address - Street 1:5122 N RHETT AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-744-2265
Practice Address - Fax:843-747-4421
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4654-012111N00000X
WI4654-12111N00000X
SC4122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor