Provider Demographics
NPI:1245208768
Name:PETTET, CHRISTOPHER EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDWIN
Last Name:PETTET
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 1:2564 SUNSET POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1500
Mailing Address - Country:US
Mailing Address - Phone:727-244-6830
Mailing Address - Fax:727-797-3435
Practice Address - Street 1:2564 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1500
Practice Address - Country:US
Practice Address - Phone:727-796-8456
Practice Address - Fax:727-797-3435
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55917Medicare ID - Type Unspecified
FLP00025388Medicare ID - Type UnspecifiedRAILROAD
FLU94693Medicare UPIN