Provider Demographics
NPI:1073818514
Name:CULLISON, GERREN L (DC)
Entity Type:Individual
Prefix:
First Name:GERREN
Middle Name:L
Last Name:CULLISON
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 1:319 CANAL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47471-1203
Mailing Address - Country:US
Mailing Address - Phone:812-875-2225
Mailing Address - Fax:812-875-1068
Practice Address - Street 1:319 CANAL ST STE 1
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47471-1203
Practice Address - Country:US
Practice Address - Phone:812-875-2225
Practice Address - Fax:812-875-1068
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002555A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor