Provider Demographics
NPI:1801821921
Name:GULLA, PETER BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRADLEY
Last Name:GULLA
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 1:3510 GALLEY RD
Mailing Address - Street 2:STE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4312
Mailing Address - Country:US
Mailing Address - Phone:719-380-0138
Mailing Address - Fax:
Practice Address - Street 1:3510 GALLEY RD
Practice Address - Street 2:STE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4312
Practice Address - Country:US
Practice Address - Phone:719-380-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor