Provider Demographics
NPI:1538803564
Name:PURE MOTION CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PURE MOTION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-268-0145
Mailing Address - Street 1:109 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2917
Mailing Address - Country:US
Mailing Address - Phone:269-684-7822
Mailing Address - Fax:269-684-7088
Practice Address - Street 1:109 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2917
Practice Address - Country:US
Practice Address - Phone:269-684-7822
Practice Address - Fax:269-684-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301010933OtherSTATE LICENSE NUMBER