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General NPI Number Information
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NPI Number | 1649281726
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Entity Type | Individual
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Provider Name | MARCELLE PETRY DC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 2400 HIGHWAY 287 N SUITE 104
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City | MANSFIELD
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State | TX
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Zip | 76063-4828
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Country | US
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Telephone | 817-539-0044
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Fax | 817-539-0682
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Provider Business Mailing Address
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Address Line | 314 MESQUITE HILL DR
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City | ARLINGTON
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State | TX
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Zip | 76002-4478
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Country | US
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Telephone | 817-539-0044
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Fax | 817-539-0682
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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 | 9680
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License Number State | TX
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