Glen C Pettersen, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH8923 Issued in FL

Practice address

2451 N McMullen Booth Rd Ste 312B
Clearwater, FL 33759-1342

Phone

(727) 260-4366

Fax

(727) 222-3838

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: glen.pettersen.1@24776.direct.athenahealth.com

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.

• Wellness Worx Center PLLC

  • Chiropractor
  • Clearwater, FL
  • NPI 1871819870
  NPD (past) Authorized official
• Suncoast Total Healthcare LLC

  • Durable Medical Equipment & Medical Supplies
  • Clearwater, FL
  • NPI 1700188927
  NPD (past)
• Total Vitality Medical Group, LLC

  • Family Medicine Physician
  • Clearwater, FL
  • NPI 1376583609

  Chiropractor

  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1386865319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 N MCMULLEN BOOTH RD STE 312B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337591342",
            "telephone_number": "727-260-4366",
            "fax_number": "727-222-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 N MCMULLEN BOOTH RD STE 312B",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337591342",
            "telephone_number": "727-260-4366",
            "fax_number": "727-222-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "GLEN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH8923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandee Peterson, CRNA
• Michael Walter Peterson, CRNA
• Julia Grace Petrarca
• Samuel Petro, O.D.
• Samantha Petroshius-Crocker, LMHC
• Christopher Edwin Pettet, D.C.
• Sirrenna Petty
• Kim Ngan Thi Pham, O.D.
• Nguyen Pham, DMD
• Phamily Eye Care, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.