Provider Demographics
NPI:1881771152
Name:PLENTZ, EDWARD GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GEORGE
Last Name:PLENTZ
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 1:9909 WAMPLERS LAKE RD
Mailing Address - Street 2:P.O.BOX 721
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9503
Mailing Address - Country:US
Mailing Address - Phone:517-592-8208
Mailing Address - Fax:571-592-4796
Practice Address - Street 1:9909 WAMPLERS LAKE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-9503
Practice Address - Country:US
Practice Address - Phone:517-592-8208
Practice Address - Fax:571-592-4796
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25909Medicare UPIN
N69310002Medicare ID - Type Unspecified