Pettibon, Sam L

Pettibon, Sam L is an individual health care provider with primary practice located at 30804 Pacific Hwy S , Federal Way WA 98003-4902. He recently has only one registered license in Chiropractic Providers / Rehabilitation, which is considered as his primary health care specialty. Pettibon, Sam L can be contacted via phone (253) 839-5644.

Contact Information

Primary practice address
30804 Pacific Hwy S Federal Way WA 98003-4902
Phone: (253) 839-5644
Fax: (253) 839-2625
Website:
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Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Rehabilitation 111NR0400X 2174 Washington

Profile Details

NPI number 1386860492
LBN Legal business name Pettibon, Sam L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2007
Last updated May 2nd, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386860492 NPPES
Washington Other PE5678 REGENCE INSURANCE PROVIDE
Washington MEDICAID 2007078 REGENCE INSURANCE PROVIDE
Washington Other 73321 REGENCE INSURANCE PROVIDE

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