Provider Demographics
NPI:1093777849
Name:PUTH, NANCY ANN (DC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:PUTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96A FOSTER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1327
Mailing Address - Country:US
Mailing Address - Phone:401-647-9634
Mailing Address - Fax:401-647-0408
Practice Address - Street 1:96A FOSTER CENTER RD
Practice Address - Street 2:
Practice Address - City:FOSTER
Practice Address - State:RI
Practice Address - Zip Code:02825-1327
Practice Address - Country:US
Practice Address - Phone:401-647-9634
Practice Address - Fax:401-647-0408
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCO00277111N00000X
MA2081111N00000X
CT001574111N00000X
GACHIR006443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9017-7OtherBLUE CROSS @ BLUE SHIELD
RI401137OtherBLUE CHIP OF BC/BS
RI5946232OtherAETNA
RI44-00148OtherUNITED HEALTHCARE
RI44-00148OtherUNITED HEALTHCARE