Provider Demographics
NPI:1306918354
Name:PUETZ, PAUL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:PUETZ
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 1:111 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-532-4355
Mailing Address - Fax:507-532-2399
Practice Address - Street 1:111 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-4355
Practice Address - Fax:507-532-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1423111N00000X
MN3967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
656448OtherMEDICA
MN639625900Medicaid
MN90D32C0OtherBCBS
MN90D32C0OtherBCBS
MN639625900Medicaid