Provider Demographics
NPI:1841544616
Name:PULLUKAT, SUNIL SIMON (DC)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:SIMON
Last Name:PULLUKAT
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 1:495 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3044
Mailing Address - Country:US
Mailing Address - Phone:773-852-8423
Mailing Address - Fax:847-495-2126
Practice Address - Street 1:495 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3044
Practice Address - Country:US
Practice Address - Phone:773-852-8423
Practice Address - Fax:847-495-2126
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor