Provider Demographics
NPI:1336619626
Name:PETERSON HOLISTIC SERVICES INC.
Entity Type:Organization
Organization Name:PETERSON HOLISTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / HOLISTIC HEALTH COACH
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CPT, HHC
Authorized Official - Phone:515-829-9477
Mailing Address - Street 1:170 EVERGREEN DR APT 200C
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8724
Mailing Address - Country:US
Mailing Address - Phone:515-829-9477
Mailing Address - Fax:
Practice Address - Street 1:6989 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1540
Practice Address - Country:US
Practice Address - Phone:515-829-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty