MEDICARE: DAVID FREDERICK PETTERS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4856	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO 4856-3	OTHER	NY	WORKERS' COMPENSATION

General Provider Information

NPI Number	:	1104905512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID FREDERICK PETTERS D.C.

Provider Business Mailing Address
First Line	:	1342 NEW SENECA TPKE
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-8802
Country	:	US
Telephone Number	:	315-685-0710
Fax Number	:	315-685-8794

Provider Business Practice Location Address
First Line	:	1342 NEW SENECA TPKE
Second Line	:
City	:	SKANEATELES
State	:	NY
Zip	:	13152-8802
Country	:	US
Telephone Number	:	315-685-0710
Fax Number	:	315-685-8794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	07/08/2007

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