Provider Demographics
NPI:1811074925
Name:PETERSEN, CHRISTINA L (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:L
Last Name:PETERSEN
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 1:165 FAWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-3513
Mailing Address - Country:US
Mailing Address - Phone:845-351-2965
Mailing Address - Fax:
Practice Address - Street 1:516 ROUTE 303
Practice Address - Street 2:SUITE 3
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1309
Practice Address - Country:US
Practice Address - Phone:845-398-7771
Practice Address - Fax:845-398-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX8H511Medicare ID - Type Unspecified