Provider Demographics
NPI:1659344521
Name:PETTIET, DEVIN
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:PETTIET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27030 STATE HIGHWAY 249
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6513
Mailing Address - Country:US
Mailing Address - Phone:281-351-7272
Mailing Address - Fax:281-351-7274
Practice Address - Street 1:27030 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6513
Practice Address - Country:US
Practice Address - Phone:281-351-7272
Practice Address - Fax:281-351-7274
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC10066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV07969Medicare UPIN
TX8F1970Medicare ID - Type Unspecified