Provider Demographics
NPI:1316427669
Name:CUCULLU, CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CUCULLU
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 1:8734 MENDOCINO CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9017
Mailing Address - Country:US
Mailing Address - Phone:907-244-3541
Mailing Address - Fax:
Practice Address - Street 1:3210 DENALI ST STE 1
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4041
Practice Address - Country:US
Practice Address - Phone:907-677-6953
Practice Address - Fax:907-677-6954
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34240111N00000X
TX14863111N00000X
AK185611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor