MEDICARE: JACQUELINE M GULLEY 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	079576	IA

General Provider Information

NPI Number	:	1477035442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE M GULLEY DC

Provider Business Mailing Address
First Line	:	10699 E 600TH ST
Second Line	:
City	:	LYNN CENTER
State	:	IL
Zip	:	61262-9764
Country	:	US
Telephone Number	:	309-714-5512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 E 38TH ST STE 201B
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	309-714-5512
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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