Provider Demographics
NPI:1689792491
Name:FOLK PETTIGREW, JOELLA ELIZABETH (DC, LM)
Entity Type:Individual
Prefix:DR
First Name:JOELLA
Middle Name:ELIZABETH
Last Name:FOLK PETTIGREW
Suffix:
Gender:F
Credentials:DC, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SE SALMONBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5922
Mailing Address - Country:US
Mailing Address - Phone:360-440-6703
Mailing Address - Fax:360-895-0132
Practice Address - Street 1:1805 SE SALMONBERRY RD
Practice Address - Street 2:STE 102
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5922
Practice Address - Country:US
Practice Address - Phone:360-440-6703
Practice Address - Fax:360-895-0132
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60478751176B00000X
WACH00034480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206970OtherLABOR AND INDUSTRIES
WAV09151Medicare UPIN
WAV09151Medicare UPIN