Provider Demographics
NPI:1952480998
Name:PETERSON, DANNY KEITH (DC)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:KEITH
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 1:16101 OLD 63 SOUTH
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9477
Mailing Address - Country:US
Mailing Address - Phone:573-657-4191
Mailing Address - Fax:
Practice Address - Street 1:601 E MCCARTY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3324
Practice Address - Country:US
Practice Address - Phone:573-634-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE003799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DANNY101Medicare UPIN