Provider Demographics
NPI:1750632360
Name:PAUL J. PROL, D.C.,P.C.
Entity Type:Organization
Organization Name:PAUL J. PROL, D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PROL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-942-8770
Mailing Address - Street 1:4286 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8301
Mailing Address - Country:US
Mailing Address - Phone:616-942-8770
Mailing Address - Fax:616-942-8857
Practice Address - Street 1:4286 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8301
Practice Address - Country:US
Practice Address - Phone:616-942-8770
Practice Address - Fax:616-942-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003013111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty