MEDICARE: DR. DAVID LEE BULL 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	038007268	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0008123329	OTHER		BCBS

General Provider Information

NPI Number	:	1811098619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEE BULL DC

Provider Business Mailing Address
First Line	:	1010 ROSE HILL RD
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275
Country	:	US
Telephone Number	:	309-523-3491
Fax Number	:	309-523-3670

Provider Business Practice Location Address
First Line	:	1010 ROSE HILL RD
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275
Country	:	US
Telephone Number	:	309-523-3491
Fax Number	:	309-523-3670

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/09/2011

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