MEDICARE: DR. BRETT ALLEN MULLEN 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	DC010372	PA

General Provider Information

NPI Number	:	1700118247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ALLEN MULLEN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 825
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821-0825
Country	:	US
Telephone Number	:	570-879-2979
Fax Number	:	570-879-5044

Provider Business Practice Location Address
First Line	:	325 MAIN ST
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821-9753
Country	:	US
Telephone Number	:	570-879-2979
Fax Number	:	570-879-5044

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

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	01/15/2015

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