Provider Demographics
NPI:1154341170
Name:PURTIMAN, ANDREW J (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:PURTIMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3327
Mailing Address - Country:US
Mailing Address - Phone:480-899-5753
Mailing Address - Fax:480-899-5754
Practice Address - Street 1:1663 E RAY RD
Practice Address - Street 2:#103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1385
Practice Address - Country:US
Practice Address - Phone:480-899-5753
Practice Address - Fax:480-899-5754
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ112932Medicare PIN