Provider Demographics
NPI:1700823408
Name:PETTIGREW, STEVEN SCOTT (DC PC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SCOTT
Last Name:PETTIGREW
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19300 SW BOONES FERRY RD
Mailing Address - Street 2:SUITE D TREE CITY CHIROPRACTIC
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-692-6568
Mailing Address - Fax:503-692-7212
Practice Address - Street 1:19300 SW BOONES FERRY RD
Practice Address - Street 2:SUITE D TREE CITY CHIROPRACTIC
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-692-6568
Practice Address - Fax:503-692-7212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGHDNMedicare ID - Type Unspecified