Provider Demographics
NPI:1548447790
Name:PURDY-CANTU, NICOLE JANETTE (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JANETTE
Last Name:PURDY-CANTU
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 1:37257 MOUND RD STE C
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4111
Mailing Address - Country:US
Mailing Address - Phone:586-264-7744
Mailing Address - Fax:586-977-7711
Practice Address - Street 1:37257 MOUND RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4111
Practice Address - Country:US
Practice Address - Phone:586-264-7744
Practice Address - Fax:586-977-7711
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor