Provider Demographics
NPI:1033316252
Name:MCCULLOUGH, MARK E (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1346 COLUMBIA AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3067
Mailing Address - Country:US
Mailing Address - Phone:269-964-3300
Mailing Address - Fax:269-964-3366
Practice Address - Street 1:1346 COLUMBIA AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3067
Practice Address - Country:US
Practice Address - Phone:269-964-3300
Practice Address - Fax:269-964-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950A311080OtherBCBS OF MICHIGAN
U79668Medicare UPIN