Organization · NPI-2

Fullmer Chiropractic

Chiropractor · Providence, UT

NPI number1184949349
StatusActive
Last updated in NPPESMar 31, 2010

Details

NPI
1184949349
Entity type
Organization (NPI-2)
Legal business name
Fullmer Chiropractic
Organization subpart
No
Enumeration date
Mar 31, 2010
Last updated
Mar 31, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111N00000X Chiropractor7563542-1202UTYes

Practice location

1652 S Highway 165
Providence, UT 84332-6701

Phone 435-752-5522 · Fax 435-752-3075

Mailing address

1652 S Highway 165
Providence, UT 84332-6701

Phone 435-752-5522 · Fax 435-752-3075

Authorized official

Thomas Owen Fullmer
Owner
4357525522

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