Provider Demographics
NPI:1245213008
Name:PETERSEN, JUSTIN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 HAWAII KAI DR APT C23
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3139
Mailing Address - Country:US
Mailing Address - Phone:808-426-8827
Mailing Address - Fax:
Practice Address - Street 1:2176 LAUWILIWILI ST STE 5A
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1882
Practice Address - Country:US
Practice Address - Phone:808-425-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK413111N00000X
IDCHIA-1344111N00000X
AZ7633111N00000X
HIDC1401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor