Provider Demographics
NPI:1336133263
Name:MCCULLOUGH, JONATHAN II (DC,EMT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:MCCULLOUGH
Suffix:II
Gender:M
Credentials:DC,EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-3901
Mailing Address - Country:US
Mailing Address - Phone:215-946-0444
Mailing Address - Fax:215-946-0448
Practice Address - Street 1:35 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-3901
Practice Address - Country:US
Practice Address - Phone:215-946-0444
Practice Address - Fax:215-946-0448
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002206-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020639Medicare PIN