Provider Demographics
NPI:1770650368
Name:PURDY CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:PURDY CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-264-7744
Mailing Address - Street 1:32860 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4350
Mailing Address - Country:US
Mailing Address - Phone:586-264-7744
Mailing Address - Fax:586-977-7711
Practice Address - Street 1:32860 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4350
Practice Address - Country:US
Practice Address - Phone:586-264-7744
Practice Address - Fax:586-977-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1400061Medicaid
MIWP004111OtherCOMMERCIAL
MIWP004111OtherWORK COMP
MIT33154Medicare UPIN