Provider Demographics
NPI:1215052568
Name:MULL, WILLIAM DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:MULL
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 1:4337 NATIONAL RD W
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4712
Mailing Address - Country:US
Mailing Address - Phone:765-962-0332
Mailing Address - Fax:765-962-0332
Practice Address - Street 1:4337 NATIONAL RD W
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4712
Practice Address - Country:US
Practice Address - Phone:765-962-0332
Practice Address - Fax:765-962-0332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001539A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU48500Medicare UPIN
IN905520Medicare ID - Type Unspecified