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1538079223 NPI number — JARED I BULLUCK

NPI Number: 1538079223
Health Care Provider/Practitioner: JARED I BULLUCK

Information about “1538079223” NPI (JARED I BULLUCK) exists in 1538079223 in HTML format HTML  |  1538079223 in plain Text format TXT  |  1538079223 in PDF (Portable Document Format) PDF  |  1538079223 in an XML format XML  formats.

NPI Number : 1538079223 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538079223",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BULLUCK",
    "FirstName": "JARED",
    "MiddleName": "I",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2122 YORK RD STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK BROOK",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60523-1925",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1797 HILL RD N STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PICKERINGTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43147-7997",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "614-494-0140",
    "PracticeLocationAddressFaxNumber": "614-494-0141",
    "EnumerationDate": "09/08/2026",
    "LastUpdateDate": "09/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "PT022633",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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