Jacob Richard Petway, DC, QME, IIE, BS

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

32615 Issued in CA

Practice address

929 Azusa St
Sacramento, CA 95833-2328

Phone

(530) 315-5594

NPI assigned

Apr 29, 2013

Last updated

Apr 27, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

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.

• Gregory Stafford Chiropractic, Inc.

  dba Stafford Chiropractic

  • Chiropractor
  • Clovis, CA
  • NPI 1669634937
  NPD (past)

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1871938217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 AZUSA ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958332328",
            "telephone_number": "530-315-5594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 AZUSA ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958332328",
            "telephone_number": "530-315-5594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2209 Plaza Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Rocklin",
            "state": "CA",
            "postal_code": "957654419",
            "country_code": "US",
            "telephone_number": "888-922-2843",
            "fax_number": "855-568-2494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETWAY",
        "first_name": "JACOB",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DC, QME, IIE, BS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-29",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "32615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Pettus, NP
• Tara Sekle Pettus
• Ashley Petty
• Raymond P. Petty, DPM
• Jason Petusevsky, DO
• Roseanne E Pevec, M.D.
• William Charles Pevec, M.D.
• Nayereh G Pezeshkian
• Kevin Timothy Pfaff, RN
• Alisa Anne Pfanner

• Chiropractor in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.