Provider Demographics
NPI:1518993435
Name:PETRO, GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:PETRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 TIFFIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9504
Mailing Address - Country:US
Mailing Address - Phone:419-424-0100
Mailing Address - Fax:419-424-1188
Practice Address - Street 1:2113 TIFFIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9504
Practice Address - Country:US
Practice Address - Phone:419-424-0100
Practice Address - Fax:419-424-1188
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPE0564402Medicare PIN
T48174Medicare UPIN