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General NPI Number Information
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NPI Number | 1871938217
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Entity Type | Individual
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Provider Name | JACOB RICHARD PETWAY DC, QME, IIE, BS
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 929 AZUSA ST
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City | SACRAMENTO
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State | CA
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Zip | 95833-2328
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Country | US
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Telephone | 530-315-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 929 AZUSA ST
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City | SACRAMENTO
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State | CA
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Zip | 95833-2328
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Country | US
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Telephone | 530-315-5594
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32615
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License Number State | CA
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