MEDICARE: DR. TIMOTHY C. MCCULLOUGH DC, DABCI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0900X	Internist Chiropractor	5866	TX

General Provider Information

NPI Number	:	1093852428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C. MCCULLOUGH DC, DABCI

Provider Business Mailing Address
First Line	:	11003 RESOURCE PKWY
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77089-6141
Country	:	US
Telephone Number	:	281-481-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	11003 RESOURCE PKWY
Second Line	:	SUITE 103
City	:	HOUSTON
State	:	TX
Zip	:	77089-6141
Country	:	US
Telephone Number	:	281-481-9299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/01/2008

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