Provider Demographics
NPI:1629265970
Name:CIRULLO, BERNARD ARTHUR SR (DC)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:ARTHUR
Last Name:CIRULLO
Suffix:SR
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 1:569 W. COUNTY LINE RD.
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320
Mailing Address - Country:US
Mailing Address - Phone:909-795-2225
Mailing Address - Fax:909-546-2276
Practice Address - Street 1:569 W. COUNTY LINE RD.
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320
Practice Address - Country:US
Practice Address - Phone:909-795-2225
Practice Address - Fax:909-546-2276
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20549111N00000X
CADC20549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0205490Medicare PIN