Active NPI
George Kenneth Petruska, DC, DACRB
- Chiropractor
- Pennsburg, PA
National Provider Identifier
1255352050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC002109L
- Practice address
- 2791 Geryville Pike
Pennsburg, PA 18073-2306 - Phone
- (215) 679-3419
- Fax
- (215) 679-8866
- NPI assigned
- Jul 21, 2006
- Last updated
- May 6, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC002109L | PA | Primary |
| Rehabilitation Chiropractor | 111NR0400X | DC002109L | PA |
Addresses
Primary practice location
2791 Geryville Pike
Pennsburg, PA 18073-2306
Mailing address
2791 Geryville Pike
Pennsburg, PA 18073-2306
Phone (215) 679-3419
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 |
|---|---|---|---|
| DC002109L | PA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1255352050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2791 GERYVILLE PIKE",
"city": "PENNSBURG",
"state": "PA",
"postal_code": "180732306",
"telephone_number": "215-679-3419",
"fax_number": "215-679-8866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2791 GERYVILLE PIKE",
"city": "PENNSBURG",
"state": "PA",
"postal_code": "180732306",
"telephone_number": "215-679-3419",
"fax_number": "215-679-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUSKA",
"first_name": "GEORGE",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "DC, DACRB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "PA",
"license": "DC002109L",
"primary": true
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "PA",
"license": "DC002109L",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pennsburg, PA
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- Perkiomen Valley Pediatric Dental
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- Personal Care Pediatrics, LLC
- Douglas G Pfeiffer, D.C.
- Phoenix Dental Associates (Upper Perk Family Dental)
- Phoenix Rehabilitation and Health Services, Inc.
- Sara Elisabeth Pike, O.D.
- Sara Pileggi, BCBA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.