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General NPI Number Information
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NPI Number | 1912321308
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Entity Type | Individual
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Provider Name | MICHAEL JOHN PETRACCI D.C
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Gender | Male
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 393 E MAIN ST STE 8
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2575
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Country | US
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Telephone | 615-991-5951
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Fax |
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Provider Business Mailing Address
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Address Line | 209 CROOKED CREEK LN
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-6713
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Country | US
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Telephone | 503-949-0235
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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 | 5520
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License Number State | OR
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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 | 3443
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License Number State | TN
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