Provider Demographics
NPI:1356419733
Name:JETTE, STEVEN ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:JETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 4TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4261
Mailing Address - Country:US
Mailing Address - Phone:707-765-1928
Mailing Address - Fax:
Practice Address - Street 1:200 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4261
Practice Address - Country:US
Practice Address - Phone:707-765-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor