Provider Demographics
NPI:1083603658
Name:JOHN D FULKERSON, DC PA
Entity Type:Organization
Organization Name:JOHN D FULKERSON, DC PA
Other - Org Name:TULIA FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FULKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-995-4699
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0283
Mailing Address - Country:US
Mailing Address - Phone:806-995-4699
Mailing Address - Fax:806-995-4706
Practice Address - Street 1:132 N ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-2232
Practice Address - Country:US
Practice Address - Phone:806-995-4699
Practice Address - Fax:806-995-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066MWOtherBCBS GROUP
TX0066MWOtherBCBS GROUP