Provider Demographics
NPI:1811905565
Name:PUCKETTE, STEVEN ROBERT (DC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:PUCKETTE
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 1:822 E WASHINGTON AVE APT 730
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-6508
Mailing Address - Country:US
Mailing Address - Phone:608-698-3149
Mailing Address - Fax:
Practice Address - Street 1:8517 EXCELSIOR DR STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2910
Practice Address - Country:US
Practice Address - Phone:608-276-7635
Practice Address - Fax:608-276-7728
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3198012111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70800Medicare ID - Type Unspecified
U70580Medicare UPIN