Healthcare Provider Details

I. General information

NPI: 1467678037
Provider Name (Legal Business Name): PETRILLI CHIROPRACTIC SERVICES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11014 SE 192ND ST
RENTON WA
98055-7432
US

IV. Provider business mailing address

11014 SE 192ND ST
RENTON WA
98055-7432
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-8640
  • Fax: 253-854-2690
Mailing address:
  • Phone: 253-852-8640
  • Fax: 253-854-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT J PETRILLI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 253-852-8640