Provider Demographics
NPI:1306942149
Name:PURDY, LYNDA L (DC)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:L
Last Name:PURDY
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 1:248 3RD AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4532
Mailing Address - Country:US
Mailing Address - Phone:406-755-1113
Mailing Address - Fax:406-260-4021
Practice Address - Street 1:248 3RD AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4532
Practice Address - Country:US
Practice Address - Phone:406-755-1113
Practice Address - Fax:406-260-4021
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42101OtherBLUE CROSS BLUE SHIELD
MT162860Medicaid
MT0000162863Medicaid
MT000004424Medicare PIN