Provider Demographics
NPI:1104199249
Name:MULLEN, CHRISTINA NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15267 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3932
Mailing Address - Country:US
Mailing Address - Phone:510-331-9497
Mailing Address - Fax:
Practice Address - Street 1:2000 HEARST AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2130
Practice Address - Country:US
Practice Address - Phone:510-704-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV302ZMedicare PIN