Provider Demographics
NPI:1457424624
Name:CULLIGAN, THOMAS R IV
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:CULLIGAN
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 FEE FEE RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3807
Mailing Address - Country:US
Mailing Address - Phone:314-469-9843
Mailing Address - Fax:
Practice Address - Street 1:1601 BRYAN RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4815
Practice Address - Country:US
Practice Address - Phone:314-469-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor