Healthcare Provider Details

I. General information

NPI: 1720174220
Provider Name (Legal Business Name): ROBERTA PURDUE KUHN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 10TH AVE
PORT HURON MI
48060-3405
US

IV. Provider business mailing address

1227 10TH AVE
PORT HURON MI
48060-3405
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-6311
  • Fax: 810-985-3288
Mailing address:
  • Phone: 810-985-6311
  • Fax: 810-985-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301006507
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: