Basic Information
| Provider Information | |||||||||
| NPI: | 1689667743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETTIGREW | ||||||||
| FirstName: | CAEDIN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13030 121ST WAY NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258142800 | ||||||||
| FaxNumber: | 4258230882 | ||||||||
| Practice Location | |||||||||
| Address1: | 13030 121ST WAY NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258142800 | ||||||||
| FaxNumber: | 4258230882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CH00034043 | WA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 0395157 | 01 | WA | WA DEPT OF LABOR & INDUSTRIES | OTHER | 192264900 | 01 | FEDERA WORKER'S COMP | OTHER | G8984222 | 01 | WA | MEDICARE | OTHER |