Michael J Pettella, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH0006496 Issued in FL

Practice address

6175 S.E. 126TH Lane
Belleview, FL 34420-5208

Phone

(352) 245-8300

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael J Pettella, DC, PLLC

  • Chiropractor
  • Belleview, FL
  • NPI 1891013900
  NPD (past) Authorized official
• Degraaf Chiropractic Clinic PC

  • Chiropractor
  • North Augusta, SC
  • NPI 1164452926
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1043200140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6175 SE 126TH LN",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344205208",
            "telephone_number": "352-245-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6175 S.E. 126TH LANE",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344205208",
            "telephone_number": "352-245-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTELLA",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0006496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350052194",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Luis Perez
• Pinard Home Health Services, LLC
• Jennifer Pishotta, DC
• Molly Ann Poucher, APRN
• Julynnet Powell, RDN, LDN
• Claudia Jean Pratt

• Chiropractor in Belleview, FL
• Providers in Belleview, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.