Provider Demographics
NPI:1679904296
Name:PETERSON, LAURA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SHADY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-0034
Mailing Address - Country:US
Mailing Address - Phone:989-415-6215
Mailing Address - Fax:
Practice Address - Street 1:607 SHADY CREEK CT
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-0034
Practice Address - Country:US
Practice Address - Phone:989-415-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor