Jon M Pettibon DC Inc PS

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1455 Issued in WA

Legal business name

JON M PETTIBON DC INC PS

Practice address

3837 S 12TH St
Tacoma, WA 98405-2138

Phone

(253) 752-3501

Fax

(253) 752-3504

NPI assigned

Feb 22, 2012

Organization subpart

No

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

Authorized official

Name

Jon M Pettibon, D.C.

Title

Owner

Phone

(253) 752-3501

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1659644672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3837 S 12TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052138",
            "telephone_number": "253-752-3501",
            "fax_number": "253-752-3504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3837 S 12TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052138",
            "telephone_number": "253-752-3501",
            "fax_number": "253-752-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON M PETTIBON DC INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-22",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "PETTIBON",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-752-3501",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "1455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marcus G Jones-Moore

• Chiropractor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.