1407151269 NPI number — FULLERTON FAMILY CHIROPRACTIC PC

Table of content: (NPI 1407151269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407151269 NPI number — FULLERTON FAMILY CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FULLERTON FAMILY CHIROPRACTIC PC
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:
Provider Other Organization Name Type Code:
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:
1407151269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6508 FRANKLIN STREET
Provider Second Line Business Mailing Address:
FULLERTON FAMILY CHIROPRACTIC PC
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-677-1203
Provider Business Mailing Address Fax Number:
308-546-9921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 BROADWAY STREET
Provider Second Line Business Practice Location Address:
FULLERTON FAMILY CHIROPRACTIC PC
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68638-0852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-536-9920
Provider Business Practice Location Address Fax Number:
308-536-9921
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HADDOCK
Authorized Official First Name:
GARY
Authorized Official Middle Name:
DON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
308-536-9920

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  112 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com