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General NPI Number Information
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NPI Number | 1336416163
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Entity Type | Organization
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Legal Business Name | PETITT CHIROPRACTIC CLINIC; P.C.
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 426 W KYTLE ST
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City | CLEVELAND
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State | GA
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Zip | 30528-1336
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Country | US
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Telephone | 706-219-2317
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Fax | 706-219-2317
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Provider Business Mailing Address
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Address Line | 426 W KYTLE ST
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City | CLEVELAND
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State | GA
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Zip | 30528-1336
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Country | US
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Telephone | 706-219-2317
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Fax | 706-219-2317
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JAMES G. PETITT
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Credential | D.C.
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Telephone | 706-219-2317
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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 | CHIR005932
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License Number State | GA
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