Provider Demographics
NPI:1285173328
Name:CULLERS CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:CULLERS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CULLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-672-2385
Mailing Address - Street 1:555 W GRANADA BLVD
Mailing Address - Street 2:STE B9
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9485
Mailing Address - Country:US
Mailing Address - Phone:386-672-2385
Mailing Address - Fax:386-672-2755
Practice Address - Street 1:555 W GRANADA BLVD
Practice Address - Street 2:STE B9
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9485
Practice Address - Country:US
Practice Address - Phone:386-672-2385
Practice Address - Fax:386-672-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 2778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty