Provider Demographics
NPI:1942202932
Name:WORLEY, PAUL E JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:WORLEY
Suffix:JR
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 1:304 S MAIN ST
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-1732
Mailing Address - Country:US
Mailing Address - Phone:989-875-3500
Mailing Address - Fax:989-875-2112
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1732
Practice Address - Country:US
Practice Address - Phone:989-875-3500
Practice Address - Fax:989-875-2112
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B950145OtherBLUE CROSS PROVIDER
MI2109332Medicaid
MI950B950145OtherBLUE CROSS PROVIDER
MI2109332Medicaid