Provider Demographics
NPI:1245381631
Name:PUCKETT, SANDRA K (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:PUCKETT
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:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:AK
Mailing Address - Zip Code:99672-0708
Mailing Address - Country:US
Mailing Address - Phone:907-260-4415
Mailing Address - Fax:
Practice Address - Street 1:40135 STERLING HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8507
Practice Address - Country:US
Practice Address - Phone:907-260-4415
Practice Address - Fax:907-262-3700
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK150964Medicare ID - Type Unspecified