Craig Michael Petitgout, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

A06076 Issued in IA

Practice address

850 22ND Ave # 3
Coralville, IA 52241-1565

Phone

(319) 354-9574

Fax

(319) 834-1128

NPI assigned

Jul 10, 2006

Last updated

Nov 14, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1710911748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 22ND AVE # 3",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522411565",
            "telephone_number": "319-354-9574",
            "fax_number": "319-834-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 22ND AVE # 3",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522411565",
            "telephone_number": "319-354-9574",
            "fax_number": "319-834-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETITGOUT",
        "first_name": "CRAIG",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "A06076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160606",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Carl Peters, M.D.
• Maria Anna Sophia Petersen
• Ross Petersen, PT
• Donald C Peterson Jr., DDS
• Kathryn Amanda Peterson, OTD, OTR/L
• Petitgout, Inc.
• Jason Pfeifer, OD
• Hannah Marie Pfister
• Kathie Pham
• Pharmerica Midwest LLC (PharMerica)

• Chiropractor in Coralville, IA
• Providers in Coralville, IA by specialty
• Chiropractor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; 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.