Provider Demographics
NPI:1609086784
Name:MICHAEL B. PETTET, DC, PS
Entity Type:Organization
Organization Name:MICHAEL B. PETTET, DC, PS
Other - Org Name:BACK AND NECK CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-253-6674
Mailing Address - Street 1:11600 SE MILL PLAIN BLVD
Mailing Address - Street 2:STE 3J
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5083
Mailing Address - Country:US
Mailing Address - Phone:360-253-6674
Mailing Address - Fax:
Practice Address - Street 1:11600 SE MILL PLAIN BLVD
Practice Address - Street 2:STE 3J
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5083
Practice Address - Country:US
Practice Address - Phone:360-253-6674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034021111N00000X
OR28 3284111N00000X
WAMA000187861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U88112Medicare UPIN
AB34331Medicare ID - Type Unspecified
AB34343Medicare ID - Type Unspecified