Provider Demographics
NPI:1043595929
Name:CULLY, REG HOLTON (DC)
Entity Type:Individual
Prefix:DR
First Name:REG
Middle Name:HOLTON
Last Name:CULLY
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 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:210-318-3007
Mailing Address - Fax:210-468-0682
Practice Address - Street 1:1018 RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2465
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11891111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11891OtherCHIROPRACTIC LICENSE