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Contact Information

CHARLES J PETERSON DC PC
1203 W SHERIDAN AVE
SHENANDOAH, IA51601
 Phone: 712-246-4798
 Fax: 712-246-5613
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Chiropractor

111N00000X 35 Chiropractic
Indicates primary specialty

NPI Profile & details for CHARLES J PETERSON DC PC

NPI # 1083687636
LBN Legal business name CHARLES J PETERSON DC PC
Authorized official CHARLES PETERSON - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/13/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
IA License # 04065
IA Medicaid 0015271
IA Other 01527 WELLMARK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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