Provider Demographics
NPI:1538250469
Name:PETERMEIER, JANE (DC)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:PETERMEIER
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 1:3611 LINCOLN ST S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7727
Mailing Address - Country:US
Mailing Address - Phone:701-298-7778
Mailing Address - Fax:701-532-1297
Practice Address - Street 1:3611 LINCOLN ST S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7727
Practice Address - Country:US
Practice Address - Phone:701-298-7778
Practice Address - Fax:701-532-1297
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19442OtherBCBSND
NDU81618Medicare UPIN
ND19442Medicare ID - Type Unspecified