Provider Demographics
NPI:1003814484
Name:FULP, JOHN T (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:FULP
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 1:2840 19TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5957
Mailing Address - Country:US
Mailing Address - Phone:701-772-2670
Mailing Address - Fax:701-772-2706
Practice Address - Street 1:2840 19TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5957
Practice Address - Country:US
Practice Address - Phone:701-772-2670
Practice Address - Fax:701-772-2706
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND013490OtherBC/ND PROVIDER NUMBER
ND18198Medicaid
NDN13490OtherMEDICARE ID-PIN
ND1003950023OtherNPI GROUP NUMBER
NDN70688OtherMEDICARE GROUP NUMBER
ND1003814484OtherNPI
ND675-001OtherBC/BS ND CLINIC NUMBER