Healthcare Provider Details

I. General information

NPI: 1750384582
Provider Name (Legal Business Name): JOHN FRANCIS CULLINANE D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY CULLINANE D. C.

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 10TH ST STE B
SAINT CLOUD FL
34769-3334
US

IV. Provider business mailing address

1106 10TH ST SUITE B
SAINT CLOUD FL
34769-3332
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-5008
  • Fax: 407-892-5028
Mailing address:
  • Phone: 407-892-5008
  • Fax: 407-982-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6290
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: