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General NPI Number Information
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NPI Number | 1073566519
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Entity Type | Organization
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Legal Business Name | PETRIE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 315 S PEORIA AVE
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City | DIXON
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State | IL
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Zip | 61021-2956
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Country | US
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Telephone | 815-288-3614
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Fax | 815-285-3525
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Provider Business Mailing Address
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Address Line | 315 S PEORIA AVE
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City | DIXON
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State | IL
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Zip | 61021-2956
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Country | US
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Telephone | 815-288-3614
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Fax | 815-285-3525
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA J PETRIE
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Credential | D.C.
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Telephone | 815-288-3614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038004367
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License Number State | IL
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