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General NPI Number Information
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NPI Number | 1588968242
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Entity Type | Individual
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Provider Name | JENNIFER PETTIGREW LMP
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 12110 BRIDGEPORT WAY SW
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-579-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 60163 GASS CT APT C
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98433-1921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA60160230
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License Number State | WA
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