Provider Demographics
NPI:1861544835
Name:PETTY, BRETT ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ELIZABETH
Last Name:PETTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BRETT
Other - Middle Name:ELIZABETH
Other - Last Name:PARRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4797 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1400
Mailing Address - Country:US
Mailing Address - Phone:407-498-0222
Mailing Address - Fax:407-892-0800
Practice Address - Street 1:4797 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1400
Practice Address - Country:US
Practice Address - Phone:407-498-0222
Practice Address - Fax:407-892-0800
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8130111N00000X
TX10926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382281800Medicaid
FL6941720OtherCIGNA
FL88167OtherBLUE CROSS BLUE SHIELD
FL653996OtherUNITED HEALTH CARE
FL382281800Medicaid