Provider Demographics
NPI:1366640724
Name:PURDUM, ROBYN LEE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:LEE ANN
Last Name:PURDUM
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:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:PEACH SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86434-0328
Mailing Address - Country:US
Mailing Address - Phone:480-285-9541
Mailing Address - Fax:480-393-7740
Practice Address - Street 1:7485 E 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2241
Practice Address - Country:US
Practice Address - Phone:928-769-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU64729Medicare UPIN
WAGAB37925Medicare ID - Type Unspecified