Healthcare Provider Details

I. General information

NPI: 1942202932
Provider Name (Legal Business Name): PAUL E WORLEY JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S MAIN ST
ITHACA MI
48847-1732
US

IV. Provider business mailing address

304 S MAIN ST PO BOX 128
ITHACA MI
48847-1732
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-3500
  • Fax: 989-875-2112
Mailing address:
  • Phone: 989-875-3500
  • Fax: 989-875-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: