Provider Demographics
NPI:1871589945
Name:BULL, RICHARD B (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:BULL
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 1:7910 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3412
Mailing Address - Country:US
Mailing Address - Phone:260-489-3636
Mailing Address - Fax:260-489-3611
Practice Address - Street 1:7910 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3412
Practice Address - Country:US
Practice Address - Phone:260-489-3636
Practice Address - Fax:260-489-3611
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001415A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN383841OtherANTHEM PIN #
INU38162Medicare UPIN
IN235500AMedicare ID - Type UnspecifiedMC ID #