Provider Demographics
NPI:1649227117
Name:KOTULAK, CHRISTIAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:KOTULAK
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 1:1 COMMONS DR # F
Mailing Address - Street 2:UNIT 37
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3441
Mailing Address - Country:US
Mailing Address - Phone:603-437-0400
Mailing Address - Fax:603-437-0443
Practice Address - Street 1:1 COMMONS DR # F
Practice Address - Street 2:UNIT 37
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-437-0400
Practice Address - Fax:603-437-0443
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH697-0703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30253253Medicaid
RE737801Medicare PIN
NH30253253Medicaid