Provider Demographics
NPI:1588801492
Name:MICHAEL F PETRIE DC PA
Entity Type:Organization
Organization Name:MICHAEL F PETRIE DC PA
Other - Org Name:PETRIE CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-561-4700
Mailing Address - Street 1:410 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1423
Mailing Address - Country:US
Mailing Address - Phone:954-561-4700
Mailing Address - Fax:954-561-0812
Practice Address - Street 1:410 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1423
Practice Address - Country:US
Practice Address - Phone:954-561-4700
Practice Address - Fax:954-561-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207L00000X
FLOS-0006234207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty