Provider Demographics
NPI:1053701722
Name:KULP FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KULP FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KULP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-376-8225
Mailing Address - Street 1:20283 N LAKE PLEASANT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9701
Mailing Address - Country:US
Mailing Address - Phone:623-376-8225
Mailing Address - Fax:623-376-8227
Practice Address - Street 1:20283 N LAKE PLEASANT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9701
Practice Address - Country:US
Practice Address - Phone:623-376-8225
Practice Address - Fax:623-376-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty