Provider Demographics
NPI:1053452383
Name:DULLE, DALE EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EDWARD
Last Name:DULLE
Suffix:JR
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 1:507 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-1436
Mailing Address - Country:US
Mailing Address - Phone:419-943-1509
Mailing Address - Fax:
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-1428
Practice Address - Country:US
Practice Address - Phone:419-943-3020
Practice Address - Fax:419-943-3020
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU61687Medicare UPIN
OHDU0804471Medicare ID - Type Unspecified