Provider Demographics
NPI:1417195249
Name:BULLOCK, HAL NEILL (DC,)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:NEILL
Last Name:BULLOCK
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 1:247 BOONE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4927
Mailing Address - Country:US
Mailing Address - Phone:828-963-7675
Mailing Address - Fax:
Practice Address - Street 1:247 BOONE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4927
Practice Address - Country:US
Practice Address - Phone:828-963-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456492Medicare PIN
NCU95396Medicare UPIN