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General NPI Number Information
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NPI Number | 1750711446
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Entity Type | Organization
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Legal Business Name | PURE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 3504 S. MOORLAND ROAD
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-785-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 S. MOORLAND ROAD
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City | NEW BERLIN
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State | WI
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Zip | 53151
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Country | US
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Telephone | 262-785-1330
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GARY R EYLER
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Credential |
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Telephone | 317-509-4653
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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 | 4048012
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License Number State | WI
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