Provider Demographics
NPI:1093852428
Name:MCCULLOUGH, TIMOTHY C (DC, DABCI)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:DC, DABCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 RESOURCE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6141
Mailing Address - Country:US
Mailing Address - Phone:281-481-9299
Mailing Address - Fax:
Practice Address - Street 1:11003 RESOURCE PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6141
Practice Address - Country:US
Practice Address - Phone:281-481-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5866111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603580Medicare PIN
TXU28945Medicare UPIN