JOHN R. PETERSEN D.C. P.A. (NPI# 1194922179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194922179 |
| Entity Type | Organization |
| Organization Name | JOHN R. PETERSEN D.C. P.A. |
| Other Organization Name | SPINE & SPORTS CHIROPRACTIC |
| Practice Address |
2216 County Road D W Saint Paul MN 55112-7500 |
| Practice Telephone | 6516391066 |
| Practice Fax Number | 6516301069 |
| Mailing Telephone | 6516391066 |
| Mailing Fax Number | 6516301069 |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2008-12-03 |
| Authorized Official Name | DR. JOHN ROBERT PETERSEN (DOCTOR OF CHIROPRACTIC) |
| Authorized Official Telephone | 6516391066 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 4232 | MN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS BLUE SHIELD | 65M39SP | 01 |
| Other Name | Type Code |
|---|---|
| Spine & Sports Chiropractic | Doing Business As Name - Organization |
| Street Address |
2216 COUNTY ROAD D W |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55112-7500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497973630 | John Robert Petersen | Chiropractor | 2216 County Road D W, Saint Paul, MN 55112-7500 | 2007-04-23 |
| 1790981538 | Michael L. Maristuen D.c., P.a. | Chiropractor | 2216 County Road D W, Suite B, Saint Paul, MN 55112-7500 | 2007-06-26 |
| 1235346784 | Michael Lavern Maristuen | Chiropractor | 2216 County Road D W, Suite B, Saint Paul, MN 55112-7500 | 2007-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932729704 | Owegio Wreh | Technician | 1405 Silver Lake Road Suite 15, New Brighton, MN 55112 | 2020-04-22 |
| 1205497435 | Silver Lake Smiles Family Dentistry | Clinic/Center | 2370 Palmer Drive, New Brighton, MN 55112 | 2019-06-27 |
| 1932766169 | Matthew Thomas Hanowski | Dentist | 2442 Mounds View Boulevard, Mounds View, MN 55112 | 2019-05-22 |
| 1437619988 | Marjean Diane Leary | Registered Nurse | 338 New Brighton Road, Apt, Suite, Bldg. (optional), New Brighton, MN 55112 | 2019-03-21 |
| 1558802728 | Krishna Katira | Student in an Organized Health Care Education/Training Program | 2442 County Hwy 10, Mounds View, MN 55112 | 2017-03-20 |
| 1245781608 | Evan Fredrick Lieberman | Counselor | 1900 Silver Lake Rd, Suite 110, New Brighton, MN 55112 | 2016-10-20 |
| 1093262065 | Ryan Zinken | Nurse Practitioner | 1900 Silver Lake Road, Suite 110, New Brighton, MN 55112 | 2016-09-07 |
| 1447703228 | Alison Glodek | Social Worker | 2543 17th St Nw, New Brighton, MN 55112 | 2016-07-28 |
| 1659728194 | Ge Vang Sr. | Driver | 2160 County Road E West #205, 2160 County Road E West #205, New Brighton, MN 55112 | 2016-05-14 |
| 1114373578 | Jessica Gapinski | Specialist/Technologist | 3900 Bethel Drive, Arden Hills, MN 55112 | 2016-05-04 |
| Find all providers in zip 55112 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477785 | Samantha Nielsen | Chiropractor | 482 Snelling Ave S, Saint Paul, MN 55116-1501 | 2020-11-04 |
| 1265061709 | Saint Paul Chiropractic Pllc | Chiropractor | 91 Snelling Ave N Ste 220, Saint Paul, MN 55104-6756 | 2020-04-06 |
| 1720622806 | Andreas Ezer | Chiropractor | 33 Hamline Ave S Ste 100, Saint Paul, MN 55105-2231 | 2019-11-01 |
| 1891284733 | Abby Mae Bachmeier | Chiropractor | 333 Grand Ave Ste 102, Saint Paul, MN 55102-2584 | 2018-05-07 |
| 1801304852 | Kyle Nolan Walsh | Chiropractor | 33 Avon St S Apt 6, Saint Paul, MN 55105-3186 | 2018-01-11 |
| 1154859866 | Sara Livia Cooper | Chiropractor | 1 Water St W Ste 270, Saint Paul, MN 55107-2053 | 2017-05-24 |
| 1982146502 | Neville Lambourne | Chiropractor | 393 Dunlap St N Ste Ll38, Saint Paul, MN 55104-4202 | 2016-11-14 |
| 1457804643 | Pamela Joy Comes | Chiropractor | 1700 Rice St Ste B, Saint Paul, MN 55113-6812 | 2016-07-25 |
| 1437511995 | Andrew David Cook | Chiropractor | 21 Langford Park, Saint Paul, MN 55108-1910 | 2016-03-24 |
| 1598130924 | Chirodefense, LLC | Chiropractor | 1068 Payne Ave, Saint Paul, MN 55130-3843 | 2015-12-10 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55112 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.