Provider Demographics
NPI:1760665087
Name:CULLUM CHIROPRACTIC CENTERS INC
Entity Type:Organization
Organization Name:CULLUM CHIROPRACTIC CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CULLUM
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:904-249-2049
Mailing Address - Street 1:1427 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6309
Mailing Address - Country:US
Mailing Address - Phone:904-249-2049
Mailing Address - Fax:904-246-4116
Practice Address - Street 1:1427 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6309
Practice Address - Country:US
Practice Address - Phone:904-249-2049
Practice Address - Fax:904-246-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU40505Medicare UPIN
FL76961AMedicare PIN