Healthcare Provider Details

I. General information

NPI: 1780683243
Provider Name (Legal Business Name): RICHARD C TULLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LAWRENCE BLVD
KEYSTONE HEIGHTS FL
32656-9219
US

IV. Provider business mailing address

6286 BAKER RD
KEYSTONE HEIGHTS FL
32656-9299
US

V. Phone/Fax

Practice location:
  • Phone: 352-473-7213
  • Fax: 352-473-7214
Mailing address:
  • Phone: 352-473-7213
  • Fax: 352-473-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: