Provider Demographics
NPI:1881662880
Name:TULLY, JOANN LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:LOUISE
Last Name:TULLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 HICKMAN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4302
Mailing Address - Country:US
Mailing Address - Phone:515-421-4700
Mailing Address - Fax:515-724-7110
Practice Address - Street 1:8450 HICKMAN RD STE 7
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4302
Practice Address - Country:US
Practice Address - Phone:515-421-4700
Practice Address - Fax:515-724-7110
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAV08297Medicare UPIN
IAI16924Medicare PIN