Provider Demographics
NPI:1932120722
Name:KLUMPP, EDWARD ALLEN SR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:KLUMPP
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:ALLEN
Other - Last Name:KLUMPP
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:310 W WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4334
Mailing Address - Country:US
Mailing Address - Phone:906-228-9800
Mailing Address - Fax:906-228-9801
Practice Address - Street 1:310 W WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4334
Practice Address - Country:US
Practice Address - Phone:906-228-9800
Practice Address - Fax:906-228-9801
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E21067OtherBCBSM PERSONAL PROVIDER #
MIDP2446OtherRAILROAD MEDICARE PTAN
MI950E210670OtherBCBSM PROVIDER NUMBER
MIMI1807001OtherMEDICARE PTAN
P00305960OtherRAILROAD MEDICARE PIN NUM
V02006Medicare UPIN
MI0P30020Medicare ID - Type Unspecified