Provider Demographics
NPI:1902070816
Name:STEVEN S. PETTIGREW, D.C., P.C.
Entity Type:Organization
Organization Name:STEVEN S. PETTIGREW, D.C., P.C.
Other - Org Name:TREE CITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-692-6568
Mailing Address - Street 1:19300 SW BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9086
Mailing Address - Country:US
Mailing Address - Phone:503-692-6568
Mailing Address - Fax:503-692-7212
Practice Address - Street 1:19300 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9086
Practice Address - Country:US
Practice Address - Phone:503-692-6568
Practice Address - Fax:503-692-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR651374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGHDNMedicare PIN