Provider Demographics
NPI:1497168157
Name:PETITGOUT, INC.
Entity Type:Organization
Organization Name:PETITGOUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETITGOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-530-9011
Mailing Address - Street 1:850 22ND AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1688
Mailing Address - Country:US
Mailing Address - Phone:319-530-9011
Mailing Address - Fax:319-834-1128
Practice Address - Street 1:850 22ND AVE STE 3
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1688
Practice Address - Country:US
Practice Address - Phone:319-530-9011
Practice Address - Fax:319-834-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty