Provider Demographics
NPI:1558548677
Name:MCCULLOUGH, EDWARD FRANCIS (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRANCIS
Last Name:MCCULLOUGH
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 1:1633 SUMMIT LAKE SHORE RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9437
Mailing Address - Country:US
Mailing Address - Phone:360-810-5201
Mailing Address - Fax:
Practice Address - Street 1:2625 MARTIN WAY E STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4900
Practice Address - Country:US
Practice Address - Phone:541-779-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2296111N00000X
WI4367-12111N00000X
OR5731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3672603OtherPTAN