Individual
DR. JAY L. PETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1570 CENTURY POINT, EAGAN, MN 55121
(651) 405-3990
(651) 405-6627
Mailing address
1570 CENTURY POINT, EAGAN, MN 55121
(651) 405-3990
(651) 405-6627
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4807
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
534G2PE
BCBS
—
Enumeration date
05/23/2006
Last updated
11/16/2007
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