Provider Demographics
NPI:1023092863
Name:PUTMAN, KERVIN T (DC)
Entity type:Individual
Prefix:DR
First Name:KERVIN
Middle Name:T
Last Name:PUTMAN
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:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-0833
Mailing Address - Country:US
Mailing Address - Phone:479-437-4444
Mailing Address - Fax:479-437-3361
Practice Address - Street 1:513 MENA ST
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-3337
Practice Address - Country:US
Practice Address - Phone:479-437-4444
Practice Address - Fax:479-437-3361
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W408Medicare ID - Type Unspecified