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Organization
M BRANDON PETTKE DC PA
Active
Organization
M BRANDON PETTKE DC PA
Active
Other names
HealthSource Chiropractic & Progressive Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL BRANDON PETTKE DC (PRESIDENT/OWNER)
(817) 297-7100
Entity
Organization
Contact information
Practice address
1320 NW JOHN JONES DR, BURLESON, TX 76028-8040
(817) 297-7100
(817) 297-7193
Mailing address
1320 NW JOHN JONES DR, BURLESON, TX 76028-8040
(817) 297-7100
(817) 297-7193
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00037X
MEDICARE GROUP
TX
Enumeration date
11/06/2007
Last updated
08/24/2009
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