Provider Demographics
NPI:1699040493
Name:BULLOCK, CASEY DICKINSON (DC)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DICKINSON
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28105 TOMBALL PKWY
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3340
Mailing Address - Country:US
Mailing Address - Phone:832-341-7047
Mailing Address - Fax:
Practice Address - Street 1:28105 TOMBALL PKWY
Practice Address - Street 2:SUITE 106A
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3340
Practice Address - Country:US
Practice Address - Phone:832-341-7047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor