Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC-002206-L | PA |
NPI | 1336133263 |
---|---|
Provider Name | Dr. Jonathan Mccullough II |
First Address | Levittown, PA 19054-3901 |
Second Address | Levittown, PA 19054-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 19/11/2007 |