Provider Demographics
NPI:1346212719
Name:CULLINAN, BARRY
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:CULLINAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 STATE ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-1640
Mailing Address - Country:US
Mailing Address - Phone:641-484-8600
Mailing Address - Fax:
Practice Address - Street 1:1210 STATE ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-1640
Practice Address - Country:US
Practice Address - Phone:641-484-8600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI5928Medicare ID - Type Unspecified