Provider Demographics
NPI:1003061979
Name:GULICK, WILLIAM GEOFFREY (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEOFFREY
Last Name:GULICK
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-0128
Mailing Address - Country:US
Mailing Address - Phone:310-570-8334
Mailing Address - Fax:310-496-0288
Practice Address - Street 1:512 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5806
Practice Address - Country:US
Practice Address - Phone:310-522-5811
Practice Address - Fax:310-830-3840
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24390OtherBOARD OF CHIROPRACTIC EXAMINERS