Provider Demographics
NPI:1649281726
Name:PETRY, MARCELLE (DC)
Entity type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:
Last Name:PETRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MESQUITE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4478
Mailing Address - Country:US
Mailing Address - Phone:817-539-0044
Mailing Address - Fax:817-539-0682
Practice Address - Street 1:2400 HIGHWAY 287 N
Practice Address - Street 2:SUITE 104
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4828
Practice Address - Country:US
Practice Address - Phone:817-539-0044
Practice Address - Fax:817-539-0682
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor