Provider Demographics
NPI:1659431062
Name:FOXWORTHY, PETRICE (DC)
Entity Type:Individual
Prefix:DR
First Name:PETRICE
Middle Name:
Last Name:FOXWORTHY
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 1:4058 FLYING C RD
Mailing Address - Street 2:STE 13
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9662
Mailing Address - Country:US
Mailing Address - Phone:530-672-6451
Mailing Address - Fax:530-672-6453
Practice Address - Street 1:3370 COUNTRY CLUB DR.
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682
Practice Address - Country:US
Practice Address - Phone:530-672-6451
Practice Address - Fax:530-672-6453
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU91737Medicare UPIN
CADC0270640Medicare ID - Type Unspecified