Provider Demographics
NPI:1427499185
Name:CULLEN, JENNIFER JOELLA (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOELLA
Last Name:CULLEN
Suffix:
Gender:F
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:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:TOLAR
Mailing Address - State:TX
Mailing Address - Zip Code:76476-0294
Mailing Address - Country:US
Mailing Address - Phone:254-897-2099
Mailing Address - Fax:
Practice Address - Street 1:507 SW BIG BEND TRL STE C
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4449
Practice Address - Country:US
Practice Address - Phone:254-897-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor