Healthcare Provider Details

I. General information

NPI: 1962924480
Provider Name (Legal Business Name): DAVID PRUSS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 E 12 MILE RD
WARREN MI
48092-5644
US

IV. Provider business mailing address

19141 SUMMERWOOD CIR
HUNTINGTON BEACH CA
92648-6608
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-8100
  • Fax: 586-573-8101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: