Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003865155 |
---|---|
Provider Name | Dr. Laura C. Petrie |
First Address | Dixon, IL 61021-2956 |
Second Address | Dixon, IL 61021-2956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |