Provider Demographics
NPI:1164177648
Name:PURDY CHIROPRACTIC NORTH PLLC
Entity Type:Organization
Organization Name:PURDY CHIROPRACTIC NORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:586-752-7205
Mailing Address - Street 1:64401 VAN DYKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2586
Mailing Address - Country:US
Mailing Address - Phone:586-752-7205
Mailing Address - Fax:
Practice Address - Street 1:64401 VAN DYKE ROAD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095
Practice Address - Country:US
Practice Address - Phone:586-752-7205
Practice Address - Fax:586-281-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty