Provider Demographics
NPI:1770954943
Name:PETERSON, ROSS T (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:T
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 1:14010 ROUTE 8 89
Mailing Address - Street 2:
Mailing Address - City:WATTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16442-2922
Mailing Address - Country:US
Mailing Address - Phone:814-739-2775
Mailing Address - Fax:814-739-2606
Practice Address - Street 1:14010 ROUTE 8 89
Practice Address - Street 2:
Practice Address - City:WATTSBURG
Practice Address - State:PA
Practice Address - Zip Code:16442-2922
Practice Address - Country:US
Practice Address - Phone:814-739-2775
Practice Address - Fax:814-739-2606
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor