Provider Demographics
NPI:1508927187
Name:PULLEY, MATTHEW W (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:PULLEY
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 1:365 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1521
Mailing Address - Country:US
Mailing Address - Phone:207-989-1220
Mailing Address - Fax:207-989-1339
Practice Address - Street 1:365 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1521
Practice Address - Country:US
Practice Address - Phone:207-989-1220
Practice Address - Fax:207-989-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor