Individual
DR. BRETT JOHN PETRILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
11014 SE 192ND ST, RENTON, WA 98055-7432
(253) 852-8640
(253) 854-2690
Mailing address
11014 SE 192ND ST, RENTON, WA 98055-7432
(253) 852-8640
(253) 854-2690
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH0002201
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43666
DEPT OF L&I
WA
01
—
911498710
TAX ID#
WA
01
—
G8912328
MEDICARE PTAN
WA
01
—
PE9824
REGENCE RIDER #
WA
Enumeration date
04/17/2007
Last updated
01/14/2015
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