Provider Demographics
NPI:1285684787
Name:PETROTTA, DEBORAH ANN (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:PETROTTA
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 1:20512 SW ROY ROGERS RD
Mailing Address - Street 2:STE 150
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9930
Mailing Address - Country:US
Mailing Address - Phone:503-625-4054
Mailing Address - Fax:503-822-5077
Practice Address - Street 1:22021 SW SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9327
Practice Address - Country:US
Practice Address - Phone:503-625-4054
Practice Address - Fax:503-625-6297
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272963OtherLICENSE
OR0000QGHJKMedicare ID - Type Unspecified