=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275605545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM DANIEL CULLINS D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 07/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 S LYON AVE SUITE C
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92543-3851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-925-7609
-----------------------------------------------------
Fax | 951-765-1744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2940 W FLORIDA AVE # B
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92545-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-925-7609
-----------------------------------------------------
Fax | 951-765-1744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC0139910
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------