Provider Demographics
NPI:1417915059
Name:MULL, DALE E (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:MULL
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 1:2525 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3665
Mailing Address - Country:US
Mailing Address - Phone:419-535-1891
Mailing Address - Fax:419-535-6319
Practice Address - Street 1:2515 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3665
Practice Address - Country:US
Practice Address - Phone:419-535-1891
Practice Address - Fax:419-535-6319
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH427111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384481Medicare ID - Type Unspecified