Provider Demographics
NPI:1295775377
Name:PETERSON, CAROL M (DC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:PETERSON
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 1:2228 TURK RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:267-880-3616
Mailing Address - Fax:267-880-0623
Practice Address - Street 1:2228 TURK RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:267-880-3616
Practice Address - Fax:267-880-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006318L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE830864Medicare ID - Type Unspecified