Provider Demographics
NPI:1538838172
Name:PUCHALSKI, KEELY (ND)
Entity type:Individual
Prefix:DR
First Name:KEELY
Middle Name:
Last Name:PUCHALSKI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5392
Mailing Address - Country:US
Mailing Address - Phone:763-639-9898
Mailing Address - Fax:
Practice Address - Street 1:1521 E SHANNON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5392
Practice Address - Country:US
Practice Address - Phone:763-639-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1951175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath