Peterson, Mark Theodore

Peterson, Mark Theodore is an sole proprietor health care provider with primary practice located at 5712 Newburg Rd , Rockford IL 61108-6707. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Peterson, Mark Theodore can be contacted via phone (815) 397-8840.

Contact Information

Primary practice address
5712 Newburg Rd Rockford IL 61108-6707
Phone: (815) 397-8840
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X Illinois

Profile Details

NPI number 1558481366
LBN Legal business name Peterson, Mark Theodore
Credentials NAPRAPATH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 29th, 2007
Last updated Jul 8th, 2007 - about 19 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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