Provider Demographics
NPI:1316184179
Name:PUYAU, NATHANIEL LUKE (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:LUKE
Last Name:PUYAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4077
Mailing Address - Country:US
Mailing Address - Phone:904-246-9955
Mailing Address - Fax:904-246-9956
Practice Address - Street 1:422 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4077
Practice Address - Country:US
Practice Address - Phone:904-246-9955
Practice Address - Fax:904-246-9956
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGX422AMedicare PIN