Petersen, Robert Todd

Petersen, Robert Todd is an sole proprietor health care provider with primary practice located at 3408 Milton Ave , Dallas TX 75205-1338. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Chiropractic Providers / Sports Physician. Chiropractic Providers / Sports Physician is his primary health care specialty. Petersen, Robert Todd can be contacted via phone (214) 739-2225.

Contact Information

Primary practice address
3408 Milton Ave Dallas TX 75205-1338
Phone: (214) 739-2225
Fax: (214) 739-2228
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X Texas
Chiropractic Providers / Sports Physician 111NS0005X 9289 Texas
Chiropractic Providers / Sports Physician 111NS0005X 5118449-1202 Utah

Profile Details

NPI number 1811917172
LBN Legal business name Petersen, Robert Todd
Credentials DC, OPAC, ATC, LAT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 20th, 2006
Last updated Oct 30th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811917172 NPPES
Texas Other 607194 BCBS ID NUMBER

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