Provider Demographics
NPI:1851330021
Name:PURDY, DAVID MITCHEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MITCHEL
Last Name:PURDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SB GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5640
Mailing Address - Country:US
Mailing Address - Phone:586-465-7900
Mailing Address - Fax:586-465-2411
Practice Address - Street 1:51 SB GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5640
Practice Address - Country:US
Practice Address - Phone:586-465-7900
Practice Address - Fax:586-465-2411
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-10-05
Deactivation Date:2007-03-22
Deactivation Code:
Reactivation Date:2007-10-03
Provider Licenses
StateLicense IDTaxonomies
MI2301004596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102483OtherGREAT LAKES
MI4343188OtherAETNA
MI4805662Medicaid
MI606169OtherACN
MICH500066OtherMCARE
MI4343188OtherAETNA
T33178Medicare UPIN