Provider Demographics
NPI:1689667743
Name:PETTIGREW, CAEDIN T (DC)
Entity Type:Individual
Prefix:DR
First Name:CAEDIN
Middle Name:T
Last Name:PETTIGREW
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 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7210
Mailing Address - Country:US
Mailing Address - Phone:425-814-2800
Mailing Address - Fax:425-823-0882
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE 102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-814-2800
Practice Address - Fax:425-823-0882
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0395157OtherWA DEPT OF LABOR & INDUSTRIES
192264900OtherFEDERA WORKER'S COMP
WAG8984222OtherMEDICARE
WA8423337Medicaid