Healthcare Provider Details

I. General information

NPI: 1649305673
Provider Name (Legal Business Name): PETSCH CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W COLBY ST
WHITEHALL MI
49461-2005
US

IV. Provider business mailing address

104 W COLBY ST
WHITEHALL MI
49461-2005
US

V. Phone/Fax

Practice location:
  • Phone: 231-894-2900
  • Fax: 231-893-1144
Mailing address:
  • Phone: 231-894-2900
  • Fax: 231-893-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006906
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301400102
License Number StateMI

VIII. Authorized Official

Name: DR. PHILIP FRANK PETSCH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 231-894-2900