Provider Demographics
NPI:1669904470
Name:PETRICK, BRITTANY (LAC, MSOM)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PETRICK
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 N 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-4332
Mailing Address - Country:US
Mailing Address - Phone:928-856-0656
Mailing Address - Fax:928-404-1353
Practice Address - Street 1:1926 N 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-4332
Practice Address - Country:US
Practice Address - Phone:928-856-0656
Practice Address - Fax:928-404-1353
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist