MEDICARE: MICHAEL F PETRIE DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1588801492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL F PETRIE DC PA

Provider Business Mailing Address
First Line	:	410 NE 44TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1423
Country	:	US
Telephone Number	:	954-561-4700
Fax Number	:	954-561-0812

Provider Business Practice Location Address
First Line	:	410 NE 44TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1423
Country	:	US
Telephone Number	:	954-561-4700
Fax Number	:	954-561-0812

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LUCIE STRAWSER
Credential	:
Telephone Number	:	954-561-4700

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	08/08/2014

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