Provider Demographics
NPI:1811029994
Name:MCCULLOCH, TIMOTHY S (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:MCCULLOCH
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 1:396 RED CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2386
Mailing Address - Country:US
Mailing Address - Phone:715-231-2533
Mailing Address - Fax:715-231-2534
Practice Address - Street 1:396 RED CEDAR STEET
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2386
Practice Address - Country:US
Practice Address - Phone:715-231-2533
Practice Address - Fax:715-231-2534
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3190012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
75859Medicare ID - Type Unspecified
U67781Medicare UPIN