MEDICARE: DR. NICOLE GULLO 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	X008155-1	NY

General Provider Information

NPI Number	:	1184716359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE GULLO DC

Provider Business Mailing Address
First Line	:	3770 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3837
Country	:	US
Telephone Number	:	718-605-4093
Fax Number	:	718-605-4104

Provider Business Practice Location Address
First Line	:	3770 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3837
Country	:	US
Telephone Number	:	718-605-4093
Fax Number	:	718-605-4104

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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