Provider Demographics
NPI:1134272727
Name:MC CULLOCH, JOANIE (CMT)
Entity type:Individual
Prefix:MS
First Name:JOANIE
Middle Name:
Last Name:MC CULLOCH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 LUCILE AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209
Mailing Address - Country:US
Mailing Address - Phone:209-957-8603
Mailing Address - Fax:209-951-0448
Practice Address - Street 1:8807 THORNTON RD, STE. P
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209
Practice Address - Country:US
Practice Address - Phone:209-298-0393
Practice Address - Fax:209-951-0448
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44227175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath