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General NPI Number Information
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NPI Number | 1770644916
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Entity Type | Organization
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Legal Business Name | DR KIA VANDUSEN MCCULLEN DC PA
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 1264 COUNTY ROAD 1
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City | DUNEDIN
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State | FL
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Zip | 34698-4610
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Country | US
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Telephone | 727-744-8787
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Fax | 727-738-5888
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Provider Business Mailing Address
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Address Line | 1264 COUNTY ROAD 1
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City | DUNEDIN
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State | FL
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Zip | 34698-4610
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Country | US
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Telephone | 727-744-8787
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Fax | 727-738-5888
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Authorized Official
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Title or Position | CHIROPRACTOR-OWNER
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Name | DR. KIA MCCULLEN
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Credential | DC
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Telephone | 727-744-8787
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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 | CH4654
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License Number State | FL
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