M Brandon Pettke DC PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

9711 Issued in TX

Legal business name

M BRANDON PETTKE DC PA

Doing business as

HealthSource Chiropractic & Progressive Rehab

Practice address

1320 NW John Jones Dr
Burleson, TX 76028-8040

Phone

(817) 297-7100

Fax

(817) 297-7193

NPI assigned

Nov 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael Brandon Pettke, DC

Title

President/Owner

Phone

(817) 297-7100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• HealthSource Chiropractic & Progressive Rehab Doing business as

Locations

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251072000000",
    "number": "1235319351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 NW JOHN JONES DR",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760288040",
            "telephone_number": "817-297-7100",
            "fax_number": "817-297-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 NW JOHN JONES DR",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760288040",
            "telephone_number": "817-297-7100",
            "fax_number": "817-297-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M BRANDON PETTKE DC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2009-08-24",
        "status": "A",
        "authorized_official_last_name": "PETTKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "817-297-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "00037X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource Chiropractic & Progressive Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Burleson, TX
• Providers in Burleson, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; 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.