MEDICARE: LUKE PUCKETT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5167	KY

General Provider Information

NPI Number	:	1558501346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE PUCKETT D.C.

Provider Business Mailing Address
First Line	:	11822 DUANE POINT CIR
Second Line	:	SUITE 104
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2720
Country	:	US
Telephone Number	:	502-548-1381
Fax Number	:

Provider Business Practice Location Address
First Line	:	11822 DUANE POINT CIR
Second Line	:	SUITE 104
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2720
Country	:	US
Telephone Number	:	502-548-1381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	07/08/2010

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