Provider Demographics
NPI:1104938729
Name:PURTLE, CARIN A (DC)
Entity type:Individual
Prefix:
First Name:CARIN
Middle Name:A
Last Name:PURTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2861
Mailing Address - Country:US
Mailing Address - Phone:309-692-0123
Mailing Address - Fax:309-692-0184
Practice Address - Street 1:6811 N KNOXVILLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2861
Practice Address - Country:US
Practice Address - Phone:309-692-0123
Practice Address - Fax:309-692-0184
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor