Provider Demographics
NPI:1306058599
Name:MCCULLOCH, CHLOE MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:MELISSA
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 MARINER CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1413
Mailing Address - Country:US
Mailing Address - Phone:216-965-5566
Mailing Address - Fax:
Practice Address - Street 1:2410 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6004
Practice Address - Country:US
Practice Address - Phone:970-810-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049373207L00000X, 207LP2900X, 208VP0014X
IN01085130A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68083327Medicaid
CO324723YLL6Medicare PIN