Provider Demographics
NPI:1942525514
Name:JOHN M DULAK CHIROPRACTOR PC
Entity type:Organization
Organization Name:JOHN M DULAK CHIROPRACTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DULAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-884-7187
Mailing Address - Street 1:3230 REID DR STE D
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2553
Mailing Address - Country:US
Mailing Address - Phone:361-884-7187
Mailing Address - Fax:361-882-7350
Practice Address - Street 1:3230 REID DR STE D
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2553
Practice Address - Country:US
Practice Address - Phone:361-884-7187
Practice Address - Fax:361-882-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2380OtherCHIROPRACTIC LICENSE
TXB105333Medicare PIN
TX2380OtherCHIROPRACTIC LICENSE