Provider Demographics
NPI:1134428121
Name:PETTIGREW, CHERYLE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:CHERYLE
Middle Name:ANN
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHERYLE
Other - Middle Name:
Other - Last Name:PETTIGREW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:10300 W CHARLESTON BLVD
Mailing Address - Street 2:10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1037
Mailing Address - Country:US
Mailing Address - Phone:702-878-2225
Mailing Address - Fax:
Practice Address - Street 1:10300 W CHARLESTON BLVD
Practice Address - Street 2:10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1037
Practice Address - Country:US
Practice Address - Phone:702-878-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31909111N00000X
NVB01524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor