Provider Demographics
NPI:1508953118
Name:PUCKETT, RICHARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:PUCKETT
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 1:705 W BAILEY BOSWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1020
Mailing Address - Country:US
Mailing Address - Phone:817-306-8585
Mailing Address - Fax:817-306-8589
Practice Address - Street 1:705 W BAILEY BOSWELL RD STE 200
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1020
Practice Address - Country:US
Practice Address - Phone:817-306-8585
Practice Address - Fax:817-306-8589
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor