Provider Demographics
NPI:1447309869
Name:BULLARD, JAMES R M (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R M
Last Name:BULLARD
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 1:14110 US HWY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-589-8744
Mailing Address - Fax:772-589-4124
Practice Address - Street 1:14110 US HWY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-589-8744
Practice Address - Fax:772-589-4124
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49140Medicare UPIN
55135Medicare ID - Type Unspecified