MEDICARE: DR. BRETT ELIZABETH PETTY 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	111N00000X	Chiropractor	CH8130	FL
2	111N00000X	Chiropractor	10926	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6941720	OTHER	FL	CIGNA
3	88167	OTHER	FL	BLUE CROSS BLUE SHIELD
4	653996	OTHER	FL	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1861544835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ELIZABETH PETTY D.C.

Provider Business Mailing Address
First Line	:	4797 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1400
Country	:	US
Telephone Number	:	407-498-0222
Fax Number	:	407-892-0800

Provider Business Practice Location Address
First Line	:	4797 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1400
Country	:	US
Telephone Number	:	407-498-0222
Fax Number	:	407-892-0800

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/10/2016

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