Provider Demographics
NPI:1023087970
Name:PUCKA, JAMES M (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:PUCKA
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 S CREASY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4800
Mailing Address - Country:US
Mailing Address - Phone:765-446-0000
Mailing Address - Fax:
Practice Address - Street 1:983 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4800
Practice Address - Country:US
Practice Address - Phone:765-446-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001350A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU25354Medicare UPIN
IN815150MMMedicare ID - Type Unspecified