Provider Demographics
NPI:1700067733
Name:PETERSON, KIRK DAVID (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:DAVID
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 1:8222 S HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4012
Mailing Address - Country:US
Mailing Address - Phone:303-771-5441
Mailing Address - Fax:303-771-5513
Practice Address - Street 1:8222 S HOLLY ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4012
Practice Address - Country:US
Practice Address - Phone:303-771-5441
Practice Address - Fax:303-771-5513
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor