Provider Demographics
NPI:1245581396
Name:JPETE2, PLLC
Entity Type:Organization
Organization Name:JPETE2, PLLC
Other - Org Name:VITALL FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-212-2036
Mailing Address - Street 1:7504 86TH ST SW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6176
Mailing Address - Country:US
Mailing Address - Phone:253-212-2036
Mailing Address - Fax:253-302-4096
Practice Address - Street 1:7504 86TH ST SW
Practice Address - Street 2:SUITE 150
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6176
Practice Address - Country:US
Practice Address - Phone:253-212-2036
Practice Address - Fax:253-302-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60191318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty