Provider Demographics
NPI:1013046499
Name:PULICE, ANTHONY EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EUGENE
Last Name:PULICE
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 1:4811 N TERRITORIAL RD E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9322
Mailing Address - Country:US
Mailing Address - Phone:734-222-8434
Mailing Address - Fax:
Practice Address - Street 1:22860 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2347
Practice Address - Country:US
Practice Address - Phone:586-754-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9364307OtherPHCS ID NUMBER
MIOP03180Medicare ID - Type UnspecifiedCHIROPRACTIC SERVICES