Provider Demographics
NPI:1629701552
Name:MCCULLOCH, COLLIN ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:ROBERT
Last Name:MCCULLOCH
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 1:420 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1675
Mailing Address - Country:US
Mailing Address - Phone:608-524-2616
Mailing Address - Fax:608-524-3697
Practice Address - Street 1:420 VIKING DR
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1675
Practice Address - Country:US
Practice Address - Phone:608-524-2616
Practice Address - Fax:608-524-3697
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6003-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor