Provider Demographics
NPI:1679088751
Name:PURTELL, CHRISTOPHE RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHE
Middle Name:RICHARD
Last Name:PURTELL
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 1:1420 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7441
Mailing Address - Country:US
Mailing Address - Phone:920-379-2639
Mailing Address - Fax:
Practice Address - Street 1:1956 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6153
Practice Address - Country:US
Practice Address - Phone:920-379-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5305-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor