Provider Demographics
NPI:1356704688
Name:PULICK, BETSY A (DC)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:A
Last Name:PULICK
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 1:159 DANBURY RD UNIT 105
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3235
Mailing Address - Country:US
Mailing Address - Phone:203-403-6980
Mailing Address - Fax:203-403-6172
Practice Address - Street 1:159 DANBURY RD UNIT 105
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3235
Practice Address - Country:US
Practice Address - Phone:203-403-6980
Practice Address - Fax:203-403-6172
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2033111N00000X
CT002033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400354364Medicare PIN