Provider Demographics
NPI:1821140195
Name:MCCULLOCH, WILLIAM ALEX (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALEX
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 1:14800 ROUTE 30
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1072
Mailing Address - Country:US
Mailing Address - Phone:412-824-2600
Mailing Address - Fax:412-824-2006
Practice Address - Street 1:14800 ROUTE 30
Practice Address - Street 2:SUITE 2
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1072
Practice Address - Country:US
Practice Address - Phone:412-824-2600
Practice Address - Fax:412-824-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007696L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00205164OtherMEDICARE RAILROAD PRO #
PAP00205164OtherMEDICARE RAILROAD PRO #
PA088362Medicare ID - Type Unspecified