Provider Demographics
NPI:1255511200
Name:MCCULLOUGH FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:MCCULLOUGH FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-964-3300
Mailing Address - Street 1:1346 COLUMBIA AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3067
Mailing Address - Country:US
Mailing Address - Phone:269-964-3300
Mailing Address - Fax:269-964-3366
Practice Address - Street 1:1346 COLUMBIA AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3067
Practice Address - Country:US
Practice Address - Phone:269-964-3300
Practice Address - Fax:269-964-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM007869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950A311080OtherBCBS OF MICHIGAN
MIDB4802OtherMEDICARE RAILROAD
MIDB4802OtherMEDICARE RAILROAD
MIDB4802OtherMEDICARE RAILROAD