Dr. Anicia Gwen Peterson
Chiropractor
13743 E Shore Rd
Crosslake
, Minnesota 56442-4033
Dr. Anicia Gwen Peterson
Chiropractor
13743 E Shore Rd
Crosslake
, Minnesota 56442-4033
(218) 692-1626
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About
Features
Specialties
- Chiropractor
Languages spoken
- English
Location
First Address
- Dr. Anicia Gwen Peterson
- 13743 E Shore Rd
- Crosslake, MN
- Zip : 56442-4033
- Fax : (218) 692-1626
- Phone : (218) 692-1616
Second Address
- Dr. Anicia Gwen Peterson
- 13743 E Shore Rd
- Crosslake, MN
- Zip : 56442-4033
- Fax : (218) 692-1626
- Phone : (218) 692-1616
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 3138 | MN |
National Provider Identifier
| NPI | 1003973702 |
|---|---|
| Provider Name | Dr. Anicia Gwen Peterson |
| First Address | Crosslake, MN 56442-4033 |
| Second Address | Crosslake, MN 56442-4033 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/01/2007 |
| Last Update Date | 09/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 68D24NO | BCBS OFFICE ID # (01) | MN |
| 68D25PE | BCBS INDIVIDUAL ID # (01) | MN |
| U43462 | (02) | MN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.