Provider Demographics
NPI:1508883513
Name:MULLANACK, JOSEPH ADAM
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ADAM
Last Name:MULLANACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4706
Mailing Address - Country:US
Mailing Address - Phone:772-584-0793
Mailing Address - Fax:
Practice Address - Street 1:1406 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4706
Practice Address - Country:US
Practice Address - Phone:772-464-3831
Practice Address - Fax:772-468-8921
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor