Healthcare Provider Details

I. General information

NPI: 1881771152
Provider Name (Legal Business Name): EDWARD GEORGE PLENTZ D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 WAMPLERS LAKE RD
BROOKLYN MI
49230-9503
US

IV. Provider business mailing address

9909 WAMPLERS LAKE RD P.O.BOX 721
BROOKLYN MI
49230-9503
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-8208
  • Fax: 571-592-4796
Mailing address:
  • Phone: 517-592-8208
  • Fax: 571-592-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: