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DR. GLEN R PETERSON D.C.
NPI 1437209418
Chiropractor - Sports Physician in La Salle, IL

Active since January 11, 2007Accepts Medicare Assignment
501 1ST ST, LA SALLE, IL 61301(815) 223-4201(814) 223-4210 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Glen R Peterson D.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GLEN R PETERSON D.C. (NPI 1437209418) is an individual sports physician in La Salle, Illinois, licensed in Illinois (038-008373) and active in the NPI registry since January 2007. He is a graduate of Palmer College Chiropractic - Davenport (1994).

NPPES Registry Identity

NPI1437209418
Entity TypeIndividualMale
Primary Taxonomy111NS0005X
Provider Legal NameDR. GLEN R PETERSONCredential: D.C.
Location Address501 1ST STLa Salle, IL 61301-2416
Mailing AddressPo Box 1204La Salle, IL 61301-3204 · (815) 223-4201 · Fax (815) 223-4210
Phone(815) 223-4201
Fax(814) 223-4210
Sole ProprietorNo
Medical School CMSPalmer College Chiropractic - DavenportGraduated 1994
Enumeration DateJanuary 11, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1437209418 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractor · Sports PhysicianChiropractic Providers
Taxonomy Code111NS0005X
License✔ Licensed in IL · 038-008373
Definition
A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities.
501 1ST ST, La Salle, IL 61301
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Glen R Peterson D.c. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335337450
PECOS Enrollment IDI20101216000062

Medicare Billing Reassignment

Medicare enrollment records show Glen Peterson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Illinois Valley Chiropractic, Ltd
Same address
Sports Physician
501 1ST ST
La Salle, IL 61301
  • Reassigned Medicare billing, Illinois enrollment
NPI 1679883185 (815) 223-4201

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Chiropractic manipulative treatment, 1-2 spinal regions 98940
Chiropractic manipulative treatment focuses on adjusting your spine to improve your body's physical function. In this service, a chiropractor applies controlled force to 1-2 spinal regions. This helps to restore mobility and alleviate discomfort in those areas.
358 services26 patients

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ILLINOIS VALLEY CHIROPRACTIC, LTD
Chiropractor (Sports Physician)
501 1ST ST
LA SALLE, IL 61301
Lasalle County (815) 223-4201

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glen Peterson's NPI number?

The NPI number for Glen Peterson is 1437209418. It was assigned to this individual provider in the NPPES registry on January 11, 2007.

Where is Glen Peterson located?

Glen Peterson practices at 501 1st St, La Salle, IL 61301. The listed phone number is (815) 223-4201.

What is Glen Peterson's specialty?

The primary specialty registered for this NPI is Chiropractor, specializing in Sports Physician, with taxonomy code 111NS0005X.

Is Glen Peterson enrolled in Medicare?

Yes. Glen Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Glen Peterson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Glen Peterson reassigns Medicare benefits to Illinois Valley Chiropractic, Ltd (La Salle, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Glen Peterson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Glen Peterson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.