Provider Demographics
NPI:1558729160
Name:BULL, KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BULL
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 1:3501 MONTLIMAR PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1736
Mailing Address - Country:US
Mailing Address - Phone:251-445-2295
Mailing Address - Fax:
Practice Address - Street 1:3501 MONTLIMAR PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1736
Practice Address - Country:US
Practice Address - Phone:251-445-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor