Provider Demographics
NPI:1194064261
Name:CHRISTOPHER E. PETTET, D.C. P.A.
Entity type:Organization
Organization Name:CHRISTOPHER E. PETTET, D.C. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:PETTET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-796-8456
Mailing Address - Street 1:2564 SUNSET POINT RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1500
Mailing Address - Country:US
Mailing Address - Phone:727-796-8456
Mailing Address - Fax:727-797-3435
Practice Address - Street 1:2564 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1500
Practice Address - Country:US
Practice Address - Phone:727-796-8456
Practice Address - Fax:727-797-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7210261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00025388OtherMEDICARE ID
FL55917OtherMEDICARE ID
FLU94693Medicare UPIN