Provider Demographics
NPI:1841314796
Name:BULL, DEAN P (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:P
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 1:1616 W GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1191
Mailing Address - Country:US
Mailing Address - Phone:814-864-0271
Mailing Address - Fax:814-864-0271
Practice Address - Street 1:1616 W GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1191
Practice Address - Country:US
Practice Address - Phone:814-864-0271
Practice Address - Fax:814-864-0271
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001738L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0624186Medicaid
PA0624186Medicaid