Provider Demographics
NPI:1700118247
Name:MULLEN, BRETT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ALLEN
Last Name:MULLEN
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:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:PA
Mailing Address - Zip Code:18821-0825
Mailing Address - Country:US
Mailing Address - Phone:570-879-2979
Mailing Address - Fax:570-879-5044
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:PA
Practice Address - Zip Code:18821-9753
Practice Address - Country:US
Practice Address - Phone:570-879-2979
Practice Address - Fax:570-879-5044
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor