Provider Demographics
NPI:1073708798
Name:ALPINE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ALPINE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-3035
Mailing Address - Street 1:529 S. WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:989-732-3035
Mailing Address - Fax:989-732-7925
Practice Address - Street 1:529 S. WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-3035
Practice Address - Fax:989-732-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3216669Medicaid
MIOF97605OtherBLUE CROSS
MIOM58720Medicare PIN