Provider Demographics
NPI:1861519159
Name:PUCKETTE CHIROPRACTIC & KINESIOLOGY, S.C.
Entity type:Organization
Organization Name:PUCKETTE CHIROPRACTIC & KINESIOLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUCKETTE
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:608-276-7635
Mailing Address - Street 1:822 E WASHINGTON AVE APT 730
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-6508
Mailing Address - Country:US
Mailing Address - Phone:608-276-7635
Mailing Address - Fax:
Practice Address - Street 1:8517 EXCELSIOR DR STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2910
Practice Address - Country:US
Practice Address - Phone:608-276-7635
Practice Address - Fax:608-276-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3198261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU70580Medicare UPIN