=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366640724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBYN LEE ANN PURDUM D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 04/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7485 E 1ST ST STE G
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-769-6083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 328
-----------------------------------------------------
City | PEACH SPRINGS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86434-0328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-285-9541
-----------------------------------------------------
Fax | 480-393-7740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7594
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------