MEDICARE: DR. EDWARD FRANCIS MCCULLOUGH D.C.

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	2296	TN
2	111N00000X	Chiropractor	4367-12	WI
3	111N00000X	Chiropractor	5731	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3672603	OTHER	TN	PTAN

General Provider Information

NPI Number	:	1558548677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD FRANCIS MCCULLOUGH D.C.

Provider Business Mailing Address
First Line	:	1633 SUMMIT LAKE SHORE RD NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9437
Country	:	US
Telephone Number	:	360-810-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 MARTIN WAY E STE A
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4900
Country	:	US
Telephone Number	:	541-779-8338
Fax Number	:

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	07/13/2020

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