MEDICARE: DR. LEVI J PULVER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009059	MI

General Provider Information

NPI Number	:	1902880073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEVI J PULVER DC

Provider Business Mailing Address
First Line	:	17204 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-604-0744
Fax Number	:	616-222-0358

Provider Business Practice Location Address
First Line	:	17208 VANWAGONER
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9702
Country	:	US
Telephone Number	:	616-834-3330
Fax Number	:	616-935-0748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	11/20/2019

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