Provider Demographics
NPI:1043915200
Name:OCEANSIDE BLVD CHIROPRACTIC
Entity Type:Organization
Organization Name:OCEANSIDE BLVD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:KULLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-764-4040
Mailing Address - Street 1:4055 OCEANSIDE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5821
Mailing Address - Country:US
Mailing Address - Phone:760-764-4040
Mailing Address - Fax:760-764-4044
Practice Address - Street 1:4055 OCEANSIDE BLVD STE E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5821
Practice Address - Country:US
Practice Address - Phone:760-764-4040
Practice Address - Fax:760-764-4044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASON KULLMANN, D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-04
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty