Healthcare Provider Details

I. General information

NPI: 1326506742
Provider Name (Legal Business Name): 640RX PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 3RD AVE
FRUITPORT MI
49415-9774
US

IV. Provider business mailing address

400 N 3RD AVE
FRUITPORT MI
49415-9774
US

V. Phone/Fax

Practice location:
  • Phone: 231-747-9163
  • Fax:
Mailing address:
  • Phone: 231-747-9163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JODY LYNN GREGG-DUCHEMIN
Title or Position: PRACTITIONER
Credential: LMT
Phone: 231-747-9163