Provider Demographics
NPI:1508004227
Name:GEIGER-PUTRA, JENNY R (DC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:GEIGER-PUTRA
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 1:104 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4302
Mailing Address - Country:US
Mailing Address - Phone:262-514-3600
Mailing Address - Fax:262-514-3836
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4302
Practice Address - Country:US
Practice Address - Phone:262-514-3600
Practice Address - Fax:262-514-3836
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3469-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor