Provider Demographics
NPI:1841357548
Name:PETERSON, DEBRA SUE (DC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SUE
Last Name:PETERSON
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 1:1952 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-4644
Mailing Address - Country:US
Mailing Address - Phone:714-283-2105
Mailing Address - Fax:714-283-2113
Practice Address - Street 1:1952 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-4644
Practice Address - Country:US
Practice Address - Phone:714-283-2105
Practice Address - Fax:714-283-2113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDC15844Medicare UPIN
CADC15844Medicare ID - Type Unspecified