Provider Demographics
NPI:1952338436
Name:PUTMAN, MICHAEL D (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
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 1:584 N SUNRISE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3035
Mailing Address - Country:US
Mailing Address - Phone:916-781-2600
Mailing Address - Fax:916-781-2765
Practice Address - Street 1:584 N SUNRISE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3035
Practice Address - Country:US
Practice Address - Phone:916-781-2600
Practice Address - Fax:916-781-2765
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0233541Medicare PIN
CAU64792Medicare UPIN