Provider Demographics
NPI:1669559621
Name:PUTTY, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:PUTTY
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 1:260 BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8725
Mailing Address - Country:US
Mailing Address - Phone:270-886-0068
Mailing Address - Fax:270-890-6068
Practice Address - Street 1:260 BURLEY AVE.
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240
Practice Address - Country:US
Practice Address - Phone:270-886-0068
Practice Address - Fax:270-890-6068
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY350055887OtherRAILROAD MEDICARE
KY000000188786OtherANTHEM BCBS
KY601626OtherWELLCARE
KY85002541Medicaid
KY6091801Medicare ID - Type Unspecified
KY601626OtherWELLCARE