Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC006933L | PA |
NPI | 1245373810 |
---|---|
Provider Name | Dr. Paul Michael Pettay |
First Address | Lancaster, PA 17601-3505 |
Second Address | Lancaster, PA 17601-4608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |