Provider Demographics
NPI:1811098619
Name:BULL, DAVID LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:BULL
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 1:1010 ROSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61275
Mailing Address - Country:US
Mailing Address - Phone:309-523-3491
Mailing Address - Fax:309-523-3670
Practice Address - Street 1:1010 ROSE HILL RD
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:IL
Practice Address - Zip Code:61275
Practice Address - Country:US
Practice Address - Phone:309-523-3491
Practice Address - Fax:309-523-3670
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0008123329OtherBCBS
0008123329OtherBCBS