Provider Demographics
NPI:1457332678
Name:DULAK, JOHN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:DULAK
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 1:3230 REID DR STE D
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2553
Mailing Address - Country:US
Mailing Address - Phone:361-884-7187
Mailing Address - Fax:361-882-7350
Practice Address - Street 1:3230 REID DR STE D
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2553
Practice Address - Country:US
Practice Address - Phone:361-884-7187
Practice Address - Fax:361-882-7350
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13086Medicare UPIN
TXTXB105334Medicare PIN