Provider Demographics
NPI:1912149766
Name:PETERSON, CHRIS JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:JOHN
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 1:801 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1207
Mailing Address - Country:US
Mailing Address - Phone:609-584-1313
Mailing Address - Fax:608-584-1972
Practice Address - Street 1:801 HUGHES DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1207
Practice Address - Country:US
Practice Address - Phone:609-584-1313
Practice Address - Fax:608-584-1972
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31216111N00000X
NJ38MC00685600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31216OtherSTATE LISENCE
NJ38MC00685600OtherSTATE OF NJ LICENSE