Provider Demographics
NPI:1962556670
Name:PETRELLA, ANNA GELTRUDE (DC)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GELTRUDE
Last Name:PETRELLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BEDFORD CENTER RD
Mailing Address - Street 2:STE A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5448
Mailing Address - Country:US
Mailing Address - Phone:603-472-3011
Mailing Address - Fax:603-472-8788
Practice Address - Street 1:124 BEDFORD CENTER RD
Practice Address - Street 2:STE A
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5448
Practice Address - Country:US
Practice Address - Phone:603-472-3011
Practice Address - Fax:603-472-8788
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH126-0493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH126-0493OtherSTATE LICENCE #
RE2984Medicare ID - Type Unspecified
U-47843Medicare UPIN