Provider Demographics
NPI:1235980186
Name:DUCKETT, SAMANTHA (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 NORVELL CT
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9709
Mailing Address - Country:US
Mailing Address - Phone:816-682-1634
Mailing Address - Fax:
Practice Address - Street 1:3081 NORVELL CT
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9709
Practice Address - Country:US
Practice Address - Phone:816-682-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor