Provider Demographics
NPI:1467678037
Name:PETRILLI CHIROPRACTIC SERVICES PS
Entity Type:Organization
Organization Name:PETRILLI CHIROPRACTIC SERVICES PS
Other - Org Name:CHIROPRACTIC HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-852-8640
Mailing Address - Street 1:11014 SE 192ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7432
Mailing Address - Country:US
Mailing Address - Phone:253-852-8640
Mailing Address - Fax:253-854-2690
Practice Address - Street 1:11014 SE 192ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7432
Practice Address - Country:US
Practice Address - Phone:253-852-8640
Practice Address - Fax:253-854-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA43666OtherL&I GROUP NUMBER
WAGAB21432Medicare PIN