Provider Demographics
NPI:1508057415
Name:PURVIS CHIROPRACTIC CLINIC,PLC
Entity Type:Organization
Organization Name:PURVIS CHIROPRACTIC CLINIC,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:LINNELL
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-323-1589
Mailing Address - Street 1:3076 STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2349
Mailing Address - Country:US
Mailing Address - Phone:804-323-1589
Mailing Address - Fax:804-323-3895
Practice Address - Street 1:3076 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-2349
Practice Address - Country:US
Practice Address - Phone:804-323-1589
Practice Address - Fax:804-323-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU96663Medicare UPIN