Individual
DR. RENEE IRENE PETHTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
23610 VAN BORN RD, DEARBORN HEIGHTS, MI 48125-2356
(313) 291-1060
(313) 291-1089
Mailing address
23610 VAN BORN RD, DEARBORN HEIGHTS, MI 48125-2356
(313) 291-1060
(313) 291-1089
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301007287
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11285842
CAQH
MI
01
—
140343
PREFERRED CHOICES
MI
05
—
3264700
—
MI
01
—
950H253460
BCBS PPO
MI
01
—
P101064
BLUECARE NETWORK
MI
01
—
RP007287
BCBS ID
MI
01
—
U61953
HAP
MI
Enumeration date
05/08/2006
Last updated
02/05/2024
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