Provider Demographics
NPI:1083919245
Name:PETTY, JOHN ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADAM
Last Name:PETTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1295 OLD US 1
Mailing Address - Street 2:SUITE F
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-246-2099
Mailing Address - Fax:910-246-2098
Practice Address - Street 1:1295 OLD US 1
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-246-2099
Practice Address - Fax:910-246-2098
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008477111N00000X
NC4185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor