Provider Demographics
NPI:1265444210
Name:CULLUM, FOSTER JAMES IV (DC)
Entity Type:Individual
Prefix:DR
First Name:FOSTER
Middle Name:JAMES
Last Name:CULLUM
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:FOSTER
Other - Middle Name:JAMES
Other - Last Name:CULLUM
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 47125
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-7125
Mailing Address - Country:US
Mailing Address - Phone:904-477-4480
Mailing Address - Fax:904-683-5619
Practice Address - Street 1:3728 PHILLIPS HWY STE 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6840
Practice Address - Country:US
Practice Address - Phone:904-477-4480
Practice Address - Fax:904-683-5619
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3818543Medicaid
FL76961AMedicare ID - Type Unspecified
FL3818543Medicaid