Jay L. Pettis, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4807 Issued in MN

Practice address

1570 Century Point
Eagan, MN 55121

Phone

(651) 405-3990

Fax

(651) 405-6627

NPI assigned

May 23, 2006

Last updated

Nov 16, 2007By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pettis Chiropractic

  • Chiropractor
  • Eagan, MN
  • NPI 1316115934
  NPD (past) Authorized official
• Healing Touch Chiropractic

  • Chiropractor
  • Eagan, MN
  • NPI 1639373319
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1548215320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 CENTURY POINT",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55121",
            "telephone_number": "651-405-3990",
            "fax_number": "651-405-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 CENTURY POINT",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55121",
            "telephone_number": "651-405-3990",
            "fax_number": "651-405-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "JAY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "534G2PE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald Frederick Peterson, MD
• Jessica Ann Peterson, LICSW, CSW-PIP
• Jimmie Ray Peterson
• Megan Peterson, OTR/L
• Pettis Chiropractic
• Shayna Sharyl Phelps
• Saquoria Pickett
• Mikayla Pieper
• Courtney Pierre, MA, LPCC, LADC
• Andrea Pierson, RN

• Chiropractor in Eagan, MN
• Providers in Eagan, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.