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General NPI Number Information
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NPI Number | 1730631268
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Entity Type | Organization
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Legal Business Name | MCCULLY ATLAS SPINAL CARE CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 4655 HOEN AVE SUITE 8
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City | SANTA ROSA
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State | CA
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Zip | 95405-7800
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Country | US
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Telephone | 707-568-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 4655 HOEN AVE SUITE 8
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City | SANTA ROSA
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State | CA
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Zip | 95405-7800
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Country | US
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Telephone | 707-568-6900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUCAS MCCULLY
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Credential | D.C.
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Telephone | 707-568-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC31489
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License Number State | CA
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