Provider Demographics
NPI:1851600241
Name:PETKE, RICHARD ALAN (ND)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:PETKE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 20TH ST
Mailing Address - Street 2:STE P2060
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1445
Mailing Address - Country:US
Mailing Address - Phone:206-900-6626
Mailing Address - Fax:
Practice Address - Street 1:1300 N 20TH ST
Practice Address - Street 2:STE P2060
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-1445
Practice Address - Country:US
Practice Address - Phone:206-900-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1207175F00000X
WANT60682875175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath