MEDICARE: DR. RICHARD C TULLER D.C.

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	111N00000X	Chiropractor	4527	FL

General Provider Information

NPI Number	:	1780683243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C TULLER D.C.

Provider Business Mailing Address
First Line	:	6286 BAKER RD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9299
Country	:	US
Telephone Number	:	352-473-7213
Fax Number	:	352-473-7214

Provider Business Practice Location Address
First Line	:	310 S LAWRENCE BLVD
Second Line	:
City	:	KEYSTONE HEIGHTS
State	:	FL
Zip	:	32656-9219
Country	:	US
Telephone Number	:	352-473-7213
Fax Number	:	352-473-7214

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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