Provider Demographics
NPI:1508213893
Name:KEVIN R. PETT PHD
Entity Type:Organization
Organization Name:KEVIN R. PETT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD.
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DAOM, DOM
Authorized Official - Phone:703-587-1244
Mailing Address - Street 1:3062 NW KELLY HILL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7023
Mailing Address - Country:US
Mailing Address - Phone:703-587-1244
Mailing Address - Fax:541-330-6635
Practice Address - Street 1:39 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3310
Practice Address - Country:US
Practice Address - Phone:541-330-0334
Practice Address - Fax:541-330-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01101171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty