Provider Demographics
NPI:1780969733
Name:TULLIS, AUDREY ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:TULLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-3637
Mailing Address - Country:US
Mailing Address - Phone:620-717-2734
Mailing Address - Fax:
Practice Address - Street 1:3528 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3637
Practice Address - Country:US
Practice Address - Phone:620-717-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor