Provider Demographics
NPI:1407108871
Name:PURIFICATI, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PURIFICATI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:PURIFICATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:550 OKEECHOBEE BLVD
Mailing Address - Street 2:1814
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6317
Mailing Address - Country:US
Mailing Address - Phone:845-978-7380
Mailing Address - Fax:
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:306
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:845-978-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor