Provider Demographics
NPI:1154328540
Name:PETTIT, RICHARD E (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:PETTIT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TOWNSEND ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-1131
Mailing Address - Country:US
Mailing Address - Phone:419-752-4905
Mailing Address - Fax:419-752-4905
Practice Address - Street 1:19 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:OH
Practice Address - Zip Code:44837-1131
Practice Address - Country:US
Practice Address - Phone:419-752-4905
Practice Address - Fax:419-752-4905
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34117335800OtherWORKERS COMPENSATION
OH0232108Medicaid
OHPE0389712Medicare ID - Type Unspecified
OHT46527Medicare UPIN