Provider Demographics
NPI:1942212451
Name:MULLIN, DAVID THOMAS (DC, MAOM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:MULLIN
Suffix:
Gender:M
Credentials:DC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WATERFALL DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9535
Mailing Address - Country:US
Mailing Address - Phone:417-343-8854
Mailing Address - Fax:417-447-1769
Practice Address - Street 1:1266 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7209
Practice Address - Country:US
Practice Address - Phone:417-882-1000
Practice Address - Fax:417-447-1769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008980111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO190381OtherBLUE CROSS BLUE SHIELD
MO226762OtherCOVENTRY
MO9355033OtherPHCS
MO667565OtherUNITED HEALTH CARE
MO674377OtherHEALTHLINK
MO674377OtherHEALTHLINK