Active NPI
Brett John Petrilli, D.C.
- Chiropractor
- Renton, WA
National Provider Identifier
1114143237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH0002201
- Practice address
- 11014 SE 192ND St
Renton, WA 98055-7432 - Phone
- (253) 852-8640
- Fax
- (253) 854-2690
- NPI assigned
- Apr 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH0002201 | WA | Primary |
Addresses
Primary practice location
11014 SE 192ND St
Renton, WA 98055-7432
Mailing address
11014 SE 192ND St
Renton, WA 98055-7432
Phone (253) 852-8640
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 911498710 | Other | WA | TAX ID# |
| PE9824 | Other | WA | REGENCE RIDER # |
| 43666 | Other | WA | DEPT OF L&I |
| G8912328 | Other | WA | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH0002201 | WA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marsh Chiropractic, PS | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421193600000",
"number": "1114143237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11014 SE 192ND ST",
"city": "RENTON",
"state": "WA",
"postal_code": "980557432",
"telephone_number": "253-852-8640",
"fax_number": "253-854-2690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11014 SE 192ND ST",
"city": "RENTON",
"state": "WA",
"postal_code": "980557432",
"telephone_number": "253-852-8640",
"fax_number": "253-854-2690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILLI",
"first_name": "BRETT",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2015-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH0002201",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID#",
"identifier": "911498710",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE RIDER #",
"identifier": "PE9824",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF L&I",
"identifier": "43666",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "G8912328",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.