Healthcare Provider Details

I. General information

NPI: 1518067461
Provider Name (Legal Business Name): MICHAEL F PETRIE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 NE 44 ST
OAKLAND PARK FL
33334
US

IV. Provider business mailing address

410 NE 44 ST
OAKLAND PARK FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 954-561-4700
  • Fax: 954-561-0812
Mailing address:
  • Phone: 954-561-4700
  • Fax: 954-561-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: