Healthcare Provider Details

I. General information

NPI: 1982762811
Provider Name (Legal Business Name): STEPHEN TULLIUS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 N 11TH ST
GROVER BEACH CA
93433-2126
US

IV. Provider business mailing address

192 N 11TH ST
GROVER BEACH CA
93433-2126
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-1566
  • Fax: 805-481-5281
Mailing address:
  • Phone: 805-481-1566
  • Fax: 805-481-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC28750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: