Provider Demographics
NPI:1699845248
Name:DANIEL J CULLITON DC PC
Entity Type:Organization
Organization Name:DANIEL J CULLITON DC PC
Other - Org Name:VALLEY CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLITON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-867-5500
Mailing Address - Street 1:3706 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-867-5500
Mailing Address - Fax:910-867-4120
Practice Address - Street 1:3706 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4963
Practice Address - Country:US
Practice Address - Phone:910-867-5500
Practice Address - Fax:910-867-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2863111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0849YOtherBLUE CROSS ID
NC1053409649OtherTYPE 1 NPI
NC890849YMedicaid
NC1053409649OtherTYPE 1 NPI
NC890849YMedicaid
NC2454148Medicare ID - Type UnspecifiedMEDICARE ID