Provider Demographics
NPI:1578722450
Name:ENRIGHT, PAUL ADAM (LIC ACUP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ADAM
Last Name:ENRIGHT
Suffix:
Gender:M
Credentials:LIC ACUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26433 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9113
Mailing Address - Country:US
Mailing Address - Phone:574-807-8157
Mailing Address - Fax:
Practice Address - Street 1:111 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1994
Practice Address - Country:US
Practice Address - Phone:574-647-2600
Practice Address - Fax:574-239-6460
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000018A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist