Provider Demographics
NPI:1740579192
Name:KUKREJA, PUNITA SOOD (DC)
Entity Type:Individual
Prefix:DR
First Name:PUNITA
Middle Name:SOOD
Last Name:KUKREJA
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 1:4200 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-5420
Mailing Address - Country:US
Mailing Address - Phone:262-498-6479
Mailing Address - Fax:
Practice Address - Street 1:4200 QUAIL ST
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-5420
Practice Address - Country:US
Practice Address - Phone:262-498-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor