Provider Demographics
NPI:1639196165
Name:PETRUCCI, KATHLEEN KRISTINA (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KRISTINA
Last Name:PETRUCCI
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 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-493-4463
Mailing Address - Fax:215-493-1810
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 1405
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:215-493-4463
Practice Address - Fax:215-493-1810
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADL06880L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68456Medicare UPIN