Petersen, Russell N
Petersen, Russell N is an individual health care provider with primary practice located at 4027 S Business Dr , Sheboygan WI 53081-1261. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Petersen, Russell N can be contacted via phone (920) 459-9090.Contact Information
Primary practice address
4027 S Business Dr
Sheboygan WI 53081-1261
Phone: (920) 459-9090
Fax: (920) 459-7426
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 4058-012 | Wisconsin |
Profile Details
| NPI number | 1164550620 |
|---|---|
| LBN Legal business name | Petersen, Russell N |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 28th, 2007 |
| Last updated | Jan 23rd, 2012 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164550620 | NPPES |
| Wisconsin | MEDICAID | 38834800 |
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