Provider Demographics
NPI:1568640324
Name:PETETT CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:PETETT CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PETETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-277-2225
Mailing Address - Street 1:10622 SE CARR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5406
Mailing Address - Country:US
Mailing Address - Phone:425-277-2225
Mailing Address - Fax:425-277-1591
Practice Address - Street 1:10622 SE CARR RD
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5406
Practice Address - Country:US
Practice Address - Phone:425-277-2225
Practice Address - Fax:425-277-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601459645261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG217123500Medicare PIN