Provider Demographics
NPI:1568515534
Name:KULICK, DAVID S J (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S J
Last Name:KULICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:S J
Other - Last Name:KULICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1330 AYER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9700
Mailing Address - Country:US
Mailing Address - Phone:530-918-9466
Mailing Address - Fax:
Practice Address - Street 1:1330 AYER LN
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9700
Practice Address - Country:US
Practice Address - Phone:530-918-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor