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General NPI Number Information
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NPI Number | 1811905565
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Entity Type | Individual
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Provider Name | STEVEN ROBERT PUCKETTE DC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 8517 EXCELSIOR DR STE 300
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City | MADISON
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State | WI
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Zip | 53717-2910
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Country | US
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Telephone | 608-276-7635
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Fax | 608-276-7728
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Provider Business Mailing Address
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Address Line | 822 E WASHINGTON AVE APT 730
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City | MADISON
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State | WI
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Zip | 53703-6508
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Country | US
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Telephone | 608-698-3149
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Fax |
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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 | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 3198012
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License Number State | WI
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