Provider Demographics
NPI:1386340719
Name:PUETZ, MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
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 1:1929 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-751-0572
Mailing Address - Fax:
Practice Address - Street 1:1929 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-751-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1179OtherSTATE LICENSE NUMBER