Provider Demographics
NPI:1942258496
Name:PETTIS, WILLIAM B (MS, LAC, EMAP)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:PETTIS
Suffix:
Gender:M
Credentials:MS, LAC, EMAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 KINOOLE STREET
Mailing Address - Street 2:#102-174
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:808-327-9355
Mailing Address - Fax:808-443-0405
Practice Address - Street 1:83 MAIKAI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-327-9355
Practice Address - Fax:808-443-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDOM 021171100000X
WAAC00000652171100000X
HIACU-671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist