Provider Demographics
NPI:1124774567
Name:CULLEN, PATRICK DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:CULLEN
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 1:1272 W MAIN RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-6405
Mailing Address - Country:US
Mailing Address - Phone:401-849-7011
Mailing Address - Fax:401-847-1449
Practice Address - Street 1:1272 W MAIN RD BLDG 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6405
Practice Address - Country:US
Practice Address - Phone:401-849-7011
Practice Address - Fax:401-847-1449
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00700111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic