Healthcare Provider Details

I. General information

NPI: 1912005992
Provider Name (Legal Business Name): DAVID N TULLOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 I 55 NORTH FRONTAGE RD.
JACKSON MS
39211
US

IV. Provider business mailing address

3710 I 55 NORTH FRONTAGE RD.
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-2273
  • Fax: 601-981-0578
Mailing address:
  • Phone: 601-981-2273
  • Fax: 601-981-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0816
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: