Provider Demographics
NPI:1053409649
Name:CULLITON, DANIEL JOHN (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:CULLITON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4963
Mailing Address - Country:US
Mailing Address - Phone:910-867-5500
Mailing Address - Fax:910-867-4120
Practice Address - Street 1:3706 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4963
Practice Address - Country:US
Practice Address - Phone:910-867-5500
Practice Address - Fax:910-867-4120
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC437501OtherWELLPATH ID
NC562239006OtherTAX ID
NC486753000OtherOWCP ID
NC0849YOtherBLUE CROSS ID
NC890849YMedicaid
NCU77128Medicare UPIN
NC2454148Medicare ID - Type UnspecifiedPROVIDER ID