Healthcare Provider Details

I. General information

NPI: 1912171943
Provider Name (Legal Business Name): ST CLOUD CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 701757
SAINT CLOUD FL
34770-1757
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN FRANCIS CULLINANE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 407-892-5008