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General NPI Number Information
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NPI Number | 1376086116
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Entity Type | Organization
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Legal Business Name | PURCELL INTEGRATIVE OSTEOPATHIC CLINIC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 353 MARKET ST
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City | SUNBURY
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State | PA
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Zip | 17801-3403
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Country | US
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Telephone | 570-975-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 140 16TH ST
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City | NORTHUMBERLAND
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State | PA
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Zip | 17857-9402
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Country | US
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Telephone | 518-810-5002
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL PURCELL
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Credential | D.O.
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Telephone | 518-810-5002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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