DR. JEFFREY SCOTT PETETT (NPI# 1467536656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467536656 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY SCOTT PETETT |
| Credential | D.C. |
| Practice Address |
10622 Se Carr Rd Suite A Renton WA 98055-5824 |
| Practice Telephone | 4252772225 |
| Practice Fax Number | 4252771591 |
| Mailing Telephone | 4252772225 |
| Mailing Fax Number | 4252771591 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-06-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | CHOOOO2306 | WA | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | L&I | 41194 | 01 |
| WA | 8427031 | 05 | |
| WA | TAX ID# | 911597946 | 01 |
| Street Address |
10622 SE CARR RD SUITE A |
| City | RENTON |
| State | WA |
| Zip Code | 98055-5824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457778334 | Samantha Holcomb | Massage Therapist | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5406 | 2014-03-28 |
| 1962770461 | Michael J Ehrenheim | Chiropractor | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5406 | 2011-12-12 |
| 1568743045 | Jennifer Rae Faline | Massage Therapist | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5406 | 2011-08-29 |
| 1568640324 | Petett Chiropractic Clinic, Inc. | Clinic/Center | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5406 | 2008-02-04 |
| 1548451099 | Gary Stephen Nixon | Specialist | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5406 | 2007-08-08 |
| 1144435256 | Derrick Bridges | Specialist | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5824 | 2007-05-11 |
| 1932226909 | Anne R Petett | Chiropractor | 10622 Se Carr Rd, Suite A, Renton, WA 98055-5824 | 2007-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1851804959 | Talbot Rehabilitation Center, LLC | Skilled Nursing Facility | 4430 Talbot Road South, Renton, WA 98055 | 2017-11-10 |
| 1154878668 | Nelson Family Dentistry | Dentist | 19221 108th Ave Se Suite #2, Renton, WA 98055 | 2016-09-01 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1376960138 | Madhuri Gordhan Patel | Registered Nurse | 3501 Mill Place South, Renton, WA 98055 | 2014-03-18 |
| 1912331042 | Karen Dohr | Pharmacist | 400 S. 43 Street, Renton, WA 98055 | 2013-08-26 |
| 1659637668 | Benjamin Reiss | Ophthalmology | 4300 Talbot Rd S Ste 300, Renton, WA 98055 | 2012-04-03 |
| 1205137940 | Duy Ai Quang Hoang | Pharmacist | 9431 S 196th Pl, Renton, WA 98055 | 2010-11-11 |
| 1972823664 | Erica L Ellzey | Physical Therapist | 18623 112th Ave Se, Renton, WA 98055 | 2010-06-04 |
| 1588984587 | Melissa A. Jordan | Nurse Anesthetist, Certified Registered | 4011 Talbot Rd., 5th Floor, Renton, WA 98055 | 2010-06-02 |
| Find all providers in zip 98055 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679181952 | Shaka Hatcher | Chiropractor | 720 N 10th St Ste A-348, Renton, WA 98057-5683 | 2020-07-22 |
| 1851928535 | Marnie Hansen, Pllc | Chiropractor | 18122 W Lake Desire Dr Se, Renton, WA 98058-9526 | 2020-03-24 |
| 1952875817 | Kim's Chiropractic Clinic Inc | Chiropractor | 4509 Talbot Road South, Suite 104, Renton, WA 98055-5294 | 2019-01-14 |
| 1073095386 | Renton Spine Clinic | Chiropractor | 352 Sunset Blvd N, Renton, WA 98057-5514 | 2018-09-04 |
| 1275905721 | Todd R Glass | Chiropractor | 1024 N 10th Pl #2306, Renton, WA 98057 | 2015-10-23 |
| 1275917734 | Jade Chiropractic and Wellness Center | Chiropractor | 6003 Se 2nd St, Renton, WA 98059-8549 | 2015-07-15 |
| 1821397746 | Tae Yong Kim | Chiropractor | 819 South 3rd Street, Renton, WA 98057 | 2011-03-17 |
| 1083912760 | Dale D Nguyen | Chiropractor | 1222 Bronson Way N Ste 130, Renton, WA 98057-5727 | 2011-03-04 |
| 1700182995 | Samuel John Loosli | Chiropractor | 19201 108th Ave Se Ste 101, Renton, WA 98055-7379 | 2011-02-04 |
| 1063645463 | Matthew Olaf Jensen | Chiropractor | 801 S 3rd St Ste D, Renton, WA 98057-2799 | 2009-09-01 |
| Find all providers in RENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.