Provider Demographics
NPI:1407873474
Name:PURTIMAN FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PURTIMAN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:PURTIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-899-5753
Mailing Address - Street 1:1663 E RAY RD
Mailing Address - Street 2:#103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1385
Mailing Address - Country:US
Mailing Address - Phone:480-899-5753
Mailing Address - Fax:480-899-5754
Practice Address - Street 1:1663 E RAY RD
Practice Address - Street 2:#103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1385
Practice Address - Country:US
Practice Address - Phone:480-899-5753
Practice Address - Fax:480-899-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112931Medicare PIN