MEDICARE: DR. PHILIP F. PETSCH D.C.

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	111NN1001X	Nutrition Chiropractor	2301400102	MI

General Provider Information

NPI Number	:	1619952496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP F. PETSCH D.C.

Provider Business Mailing Address
First Line	:	104 W COLBY ST
Second Line	:
City	:	WHITEHALL
State	:	MI
Zip	:	49461-2005
Country	:	US
Telephone Number	:	231-894-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 W COLBY ST
Second Line	:
City	:	WHITEHALL
State	:	MI
Zip	:	49461-2005
Country	:	US
Telephone Number	:	231-894-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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