Provider Demographics
NPI:1619952496
Name:PETSCH, PHILIP F (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:PETSCH
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 1:104 W COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-2005
Mailing Address - Country:US
Mailing Address - Phone:231-894-2900
Mailing Address - Fax:
Practice Address - Street 1:104 W COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-2005
Practice Address - Country:US
Practice Address - Phone:231-894-2900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301400102111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN98920001Medicare ID - Type Unspecified