Provider Demographics
NPI:1346386737
Name:PULLIAM, EDDIE R (DC)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:R
Last Name:PULLIAM
Suffix:
Gender:M
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:PO BOX 6776
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70469-6776
Mailing Address - Country:US
Mailing Address - Phone:985-649-0023
Mailing Address - Fax:985-661-9933
Practice Address - Street 1:2055 GAUSE BLVD E
Practice Address - Street 2:SUITE 300
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5432
Practice Address - Country:US
Practice Address - Phone:985-649-0023
Practice Address - Fax:985-661-9933
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3258AOtherBLUE CROSS AND BLUE SHIEL
LA3258AOtherBLUE CROSS AND BLUE SHIEL