Provider Demographics
NPI:1780683243
Name:TULLER, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:TULLER
Suffix:
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 1:6286 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9299
Mailing Address - Country:US
Mailing Address - Phone:352-473-7213
Mailing Address - Fax:352-473-7214
Practice Address - Street 1:310 S LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9219
Practice Address - Country:US
Practice Address - Phone:352-473-7213
Practice Address - Fax:352-473-7214
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54953Medicare UPIN
FL70192Medicare ID - Type Unspecified