Provider Demographics
NPI:1003051319
Name:PETRIE, YVOUNE KARA (DC)
Entity Type:Individual
Prefix:DR
First Name:YVOUNE
Middle Name:KARA
Last Name:PETRIE
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 1:41399 AVENIDA BARCA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1523
Mailing Address - Country:US
Mailing Address - Phone:703-462-4348
Mailing Address - Fax:
Practice Address - Street 1:410 PINE ST SE
Practice Address - Street 2:SUITE 320
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4861
Practice Address - Country:US
Practice Address - Phone:703-938-1421
Practice Address - Fax:703-938-1424
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28717111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95447Medicare UPIN