Provider Demographics
NPI:1689420358
Name:JOSHUA PETTIGREW DC LLC
Entity type:Organization
Organization Name:JOSHUA PETTIGREW DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-941-9913
Mailing Address - Street 1:11481 SW HALL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:503-941-9913
Mailing Address - Fax:
Practice Address - Street 1:11481 SW HALL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8403
Practice Address - Country:US
Practice Address - Phone:503-941-9913
Practice Address - Fax:503-941-9915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSHUA PETTIGREW DC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor