Provider Demographics
NPI:1568499093
Name:PETEET, LATOYA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:MICHELLE
Last Name:PETEET
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 1:11925 E 65TH ST
Mailing Address - Street 2:10
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-3178
Mailing Address - Country:US
Mailing Address - Phone:317-871-4902
Mailing Address - Fax:317-663-4775
Practice Address - Street 1:11925 E 65TH ST
Practice Address - Street 2:10
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-3178
Practice Address - Country:US
Practice Address - Phone:317-871-4902
Practice Address - Fax:317-663-4775
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635450OtherBLUE CROSS BLUE SHIELD
ILVO6219Medicare UPIN
IL212169Medicare ID - Type Unspecified