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General NPI Number Information
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NPI Number | 1679088751
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Entity Type | Individual
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Provider Name | CHRISTOPHE RICHARD PURTELL DC
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Gender | Male
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 1956 S KOELLER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6153
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Country | US
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Telephone | 920-379-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 FAIRFAX ST
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City | OSHKOSH
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State | WI
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Zip | 54904-7441
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Country | US
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Telephone | 920-379-2639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5305-12
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License Number State | WI
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