Provider Demographics
NPI:1679690838
Name:PETRILLO, LINDA S (DC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:PETRILLO
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 1:12673 SOUTH DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:786-242-6460
Mailing Address - Fax:786-242-6430
Practice Address - Street 1:12673 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:786-242-6460
Practice Address - Fax:786-242-6430
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
E5688ZMedicare PIN