Provider Demographics
NPI:1477760155
Name:PUCHTA, RICHARD W (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:PUCHTA
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 1:690 N MERIDIAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3586
Mailing Address - Country:US
Mailing Address - Phone:406-752-7289
Mailing Address - Fax:406-752-8679
Practice Address - Street 1:690 N MERIDIAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3586
Practice Address - Country:US
Practice Address - Phone:406-752-7289
Practice Address - Fax:406-752-8679
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0056420Medicaid
MT0056251Medicaid
MT000041441OtherBLUECROSS BLUESHIELD
MT04-01483-3OtherWORKERS COMPENSATION
MT000006559Medicare ID - Type Unspecified
MT0056251Medicaid