38D0628639 CLIA NUMBER - PETERSON CLINIC LABORATORY

Laboratory Demographics

CLIA Number: 38D0628639

Facility Name: PETERSON CLINIC LABORATORY

Facility Address:
1002 W ELM PO BOX 211
HERMISTON, OR
ZIP 97838
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Facility Phone Number: 541 567-6277

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437273497

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	38D0628639
LAB Type	Physician Office
Facility Name	PETERSON CLINIC LABORATORY
Street	1002 W ELM PO BOX 211
City	HERMISTON
State	OR
ZIP	97838
Phone	541 567-6277
CertificateType	4
CertificateEffectiveDate	1/1/2024
CertificateExpirationDate	12/31/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024