Pettibon Chiropractic Clinic of Federal Way Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

199010175600BL Issued in WA

Legal business name

PETTIBON CHIROPRACTIC CLINIC OF FEDERAL WAY INC.

Practice address

30804 Pacific Hwy S
Federal Way, WA 98003-4902

Phone

(253) 839-5644

Fax

(253) 839-2625

NPI assigned

May 1, 2012

Organization subpart

No

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

Authorized official

Name

Sam L Pettibon, D.C.NPI 1386860492

Title

Owner

Phone

(253) 839-5644

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sam L Pettibon, D.O.

  • Rehabilitation Chiropractor
  • Federal Way, WA
  • NPI 1386860492
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346716800000",
    "number": "1134487846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30804 PACIFIC HWY S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034902",
            "telephone_number": "253-839-5644",
            "fax_number": "253-839-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30804 PACIFIC HWY S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034902",
            "telephone_number": "253-839-5644",
            "fax_number": "253-839-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTIBON CHIROPRACTIC CLINIC OF FEDERAL WAY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-09-04",
        "status": "A",
        "authorized_official_last_name": "PETTIBON",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-839-5644",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "199010175600BL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Claire Peterson, MS, OTR/L
• Shon Peterson
• Eileen Gwendolyn Petrie, CDPT
• Todd Petrowski
• Hanna Kirsti Petry, CNM
• Sam L Pettibon, D.O.
• Anne M Pettinger, ARNP
• An Pham, O.D.
• Nhat Pham, MD
• Thanh V Pham, MD

• Chiropractor in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Chiropractor in Washington

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

Verify at the official NPI Registry.