Healthcare Provider Details

I. General information

NPI: 1811905565
Provider Name (Legal Business Name): STEVEN ROBERT PUCKETTE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 EXCELSIOR DR STE 300
MADISON WI
53717-2910
US

IV. Provider business mailing address

822 E WASHINGTON AVE APT 730
MADISON WI
53703-6508
US

V. Phone/Fax

Practice location:
  • Phone: 608-276-7635
  • Fax: 608-276-7728
Mailing address:
  • Phone: 608-698-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number3198012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: