MEDICARE: MARK E MCCULLOUGH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301007869	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950A311080	OTHER		BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1033316252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E MCCULLOUGH DC

Provider Business Mailing Address
First Line	:	1346 COLUMBIA AVE W
Second Line	:	SUITE 101
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-3067
Country	:	US
Telephone Number	:	269-964-3300
Fax Number	:	269-964-3366

Provider Business Practice Location Address
First Line	:	1346 COLUMBIA AVE W
Second Line	:	SUITE 101
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-3067
Country	:	US
Telephone Number	:	269-964-3300
Fax Number	:	269-964-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	04/23/2017

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Directions to “ MARK E MCCULLOUGH DC” Practice Location

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