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General NPI Number Information
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NPI Number | 1861519159
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Entity Type | Organization
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Legal Business Name | PUCKETTE CHIROPRACTIC & KINESIOLOGY, S.C.
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Dates
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Enumeration Date | 03/23/2007
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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 | 608-276-7635
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN R. PUCKETTE
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Credential | D. C.
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Telephone | 608-276-7635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3198
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License Number State | WI
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