Healthcare Provider Details

I. General information

NPI: 1699740167
Provider Name (Legal Business Name): MOLLY L PUCKETT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 LINCOLN WAY
WHITE OAK PA
15131-2831
US

IV. Provider business mailing address

2606 LINCOLN WAY
WHITE OAK PA
15131-2831
US

V. Phone/Fax

Practice location:
  • Phone: 412-751-4991
  • Fax:
Mailing address:
  • Phone: 412-751-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008782L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: