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General NPI Number Information
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NPI Number | 1790865384
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Entity Type | Individual
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Provider Name | JANELLE ALISE BECKER-PUKLICH D.C.
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 7975 STONE CREEK DRIVE #20
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City | CHANHASSEN
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State | MN
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Zip | 55317
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Country | US
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Telephone | 952-746-8150
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Fax | 952-746-8252
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Provider Business Mailing Address
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Address Line | 7975 STONE CREEK DRIVE #20
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City | CHANHASSEN
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State | MN
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Zip | 55317
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Country | US
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Telephone | 952-746-8150
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Fax | 952-746-8152
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3321
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License Number State | MN
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