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Organization
MICHAEL J PETTELLA, DC, PLLC
Active
Organization
MICHAEL J PETTELLA, DC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PETTELLA DC (PRESIDENT)
(352) 245-8300
Entity
Organization
Contact information
Practice address
6175 SE 126TH LN, BELLEVIEW, FL 34420-5208
(352) 245-8300
Mailing address
6175 SE 126TH LN, BELLEVIEW, FL 34420-5208
(352) 245-8300
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH0006496
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350052194
RAILROAD MEDICARE
FL
Enumeration date
05/13/2010
Last updated
05/13/2010
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