Provider Demographics
NPI:1396855128
Name:MURPHY, DUSTINE KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTINE
Middle Name:KIM
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DUSTINE
Other - Middle Name:KIM
Other - Last Name:CEPANEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:616 E 8TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2505
Mailing Address - Country:US
Mailing Address - Phone:231-929-3253
Mailing Address - Fax:231-929-3261
Practice Address - Street 1:616 E 8TH ST STE 1
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2505
Practice Address - Country:US
Practice Address - Phone:231-929-3253
Practice Address - Fax:231-929-3261
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11399239OtherCAQH