Provider Demographics
NPI:1962885087
Name:PETRY, ANNA (DC)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:PETRY
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 1:3788 55TH AVE S STE 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7331
Mailing Address - Country:US
Mailing Address - Phone:701-809-4594
Mailing Address - Fax:701-291-8778
Practice Address - Street 1:3788 55TH AVE S STE 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7331
Practice Address - Country:US
Practice Address - Phone:701-809-4594
Practice Address - Fax:701-291-8778
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1008111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor