Provider Demographics
NPI:1639226533
Name:BULLARD-KELLEY, CYNTHIA L
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BULLARD-KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-4425
Mailing Address - Country:US
Mailing Address - Phone:336-885-5200
Mailing Address - Fax:336-885-5250
Practice Address - Street 1:1920 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-4425
Practice Address - Country:US
Practice Address - Phone:336-885-5200
Practice Address - Fax:336-885-5250
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0827KOtherBLUE CROSS BLUE SHIELD
NC890827KMedicaid
NC890827KMedicaid
NC50509Medicare UPIN