Provider Demographics
NPI:1326506742
Name:640RX PLC
Entity Type:Organization
Organization Name:640RX PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GREGG-DUCHEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:231-747-9163
Mailing Address - Street 1:400 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-9774
Mailing Address - Country:US
Mailing Address - Phone:231-747-9163
Mailing Address - Fax:
Practice Address - Street 1:400 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9774
Practice Address - Country:US
Practice Address - Phone:231-747-9163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501000434OtherMASSAGE LICENSE