Provider Demographics
NPI:1477297018
Name:CULLEN, CALLIE JO (DC)
Entity Type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:JO
Last Name:CULLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-6426
Mailing Address - Country:US
Mailing Address - Phone:203-285-9196
Mailing Address - Fax:
Practice Address - Street 1:391 BOSTON POST RD STE 1
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3578
Practice Address - Country:US
Practice Address - Phone:203-799-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor