Nicholas David Petrini, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH60647239 Issued in WA

Practice address

4041 Roosevelt Way NE
Ste 101
Seattle, WA 98105-6579

Phone

(203) 312-3894

NPI assigned

Jan 26, 2011

Last updated

Oct 15, 2021By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Functional Health Consulting, LLC

  dba Vida Integrated Health

  • Sports Physician Chiropractor
  • Seattle, WA
  • NPI 1871801522
  Medicare reassignment NPD
• Pro-Form Chiropractic and Sports Injury, PLLC

  • Chiropractor
  • Seattle, WA
  • NPI 1871256180
  Authorized official Same address or phone
• Functional Health Consulting, LLC

  dba Vida Integrated Health

  • Chiropractor
  • Renton, WA
  • NPI 1598548877
  NPD
• Functional Health Consulting, LLC

  dba Vida Intagrated Health

  • Sports Physician Chiropractor
  • Kirkland, WA
  • NPI 1790261444
  NPD

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

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634256000000",
    "number": "1770888588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5534 84TH DR NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982708509",
            "telephone_number": "203-312-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 ROOSEVELT WAY NE",
            "address_2": "STE 101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056579",
            "telephone_number": "203-312-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRINI",
        "first_name": "NICHOLAS",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-26",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60647239",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X012149-1",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "WA",
            "license": "CH60647239",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Petricca
• Kyle C Petricek
• Eric Cameron Petrie, M.D.
• Ichiko Petrie, PHARM.D.
• Leanna S Petrie
• Tiana Petrini
• Cassie Marie Petro, CN
• Julia Centeno Petro, MA, LMFT
• Daniel H Petroni, M.D., PH.D.
• Jennifer Petrou, LMP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.