Provider Demographics
NPI:1932134863
Name:BULLOCK, DENNIS C (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:C
Last Name:BULLOCK
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 1:801 FM 2325
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5057
Mailing Address - Country:US
Mailing Address - Phone:512-847-5595
Mailing Address - Fax:512-847-5595
Practice Address - Street 1:801 FM 2325
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5057
Practice Address - Country:US
Practice Address - Phone:512-847-5595
Practice Address - Fax:512-847-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601081OtherBCBS
TXT12454Medicare UPIN
TX609544Medicare PIN