Provider Demographics
NPI:1801442561
Name:PETERSON, CHRISTOPHER ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLAN
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 1:905 JUNIPER ST NE STE 108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4129
Mailing Address - Country:US
Mailing Address - Phone:404-870-0109
Mailing Address - Fax:404-870-0108
Practice Address - Street 1:905 JUNIPER ST NE STE 108
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4129
Practice Address - Country:US
Practice Address - Phone:404-870-0109
Practice Address - Fax:404-870-0108
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6634111N00000X
GACHIR010205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20263639019OtherGEORGIA