Provider Demographics
NPI:1588808794
Name:CULLUM, MATTHEW R (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:CULLUM
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 1:11945 GRANDHAVEN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-8091
Mailing Address - Country:US
Mailing Address - Phone:843-357-7200
Mailing Address - Fax:843-357-7203
Practice Address - Street 1:11945 GRANDHAVEN DR
Practice Address - Street 2:SUITE F
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-8091
Practice Address - Country:US
Practice Address - Phone:843-357-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor