Provider Demographics
NPI:1801874359
Name:PUTNAM, MICHELE RENEE (DC DIPL AC NCCAOM)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:RENEE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:DC DIPL AC NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17329 KNOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5214
Mailing Address - Country:US
Mailing Address - Phone:704-921-0505
Mailing Address - Fax:866-459-1051
Practice Address - Street 1:2305 E WT HARRIS BLVD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:704-921-0505
Practice Address - Fax:704-921-0508
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1989111N00000X
015812171100000X
NCNC2319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890841FMedicaid
NC0841FOtherBCBS
U59435Medicare UPIN
2450737Medicare ID - Type Unspecified