Provider Demographics
NPI:1700622107
Name:GULICK, CHRISTOPHER GLENN (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GLENN
Last Name:GULICK
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 1:228 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-1907
Mailing Address - Country:US
Mailing Address - Phone:785-445-8659
Mailing Address - Fax:
Practice Address - Street 1:1810 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2524
Practice Address - Country:US
Practice Address - Phone:620-793-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-06316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor