Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1575 | MA |
NPI | 1154487734 |
---|---|
Provider Name | Dr. Andrew M Kulick |
First Address | Waltham, MA 02451-4318 |
Second Address | Somerville, MA 02145-3129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |