Provider Demographics
NPI:1801328091
Name:PETERSON, DALLIN LEGRAND (ND)
Entity type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:LEGRAND
Last Name:PETERSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5319
Mailing Address - Country:US
Mailing Address - Phone:253-752-7377
Mailing Address - Fax:253-752-8001
Practice Address - Street 1:5609 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5319
Practice Address - Country:US
Practice Address - Phone:253-752-7377
Practice Address - Fax:253-752-8001
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60688380175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath