Provider Demographics
NPI:1831206879
Name:DULL, LAURA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:DULL
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 1:310 W SAINT PAUL AVE
Mailing Address - Street 2:5
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5119
Mailing Address - Country:US
Mailing Address - Phone:262-542-9814
Mailing Address - Fax:262-542-9826
Practice Address - Street 1:310 W SAINT PAUL AVE
Practice Address - Street 2:5
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5119
Practice Address - Country:US
Practice Address - Phone:262-542-9814
Practice Address - Fax:262-542-9826
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38920300Medicaid
WI000035441Medicare ID - Type Unspecified
WI38920300Medicaid