Provider Demographics
NPI:1770888588
Name:PETRINI, NICHOLAS DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:PETRINI
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 1:5534 84TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-8509
Mailing Address - Country:US
Mailing Address - Phone:203-312-3894
Mailing Address - Fax:
Practice Address - Street 1:4041 ROOSEVELT WAY NE
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6579
Practice Address - Country:US
Practice Address - Phone:203-312-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60647239111NR0400X, 111N00000X
NYX012149-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician