1083603658 NPI number — JOHN D FULKERSON, DC PA

Table of content: (NPI 1083603658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083603658 NPI number — JOHN D FULKERSON, DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN D FULKERSON, DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TULIA FAMILY CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083603658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79088-0283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-995-4699
Provider Business Mailing Address Fax Number:
806-995-4706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 N ARMSTRONG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79088-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-995-4699
Provider Business Practice Location Address Fax Number:
806-995-4706
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FULKERSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-995-4699

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9985 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0066MW . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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