Provider Demographics
NPI:1245393883
Name:FULTON CHIROPRACTIC P A
Entity Type:Organization
Organization Name:FULTON CHIROPRACTIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-275-0770
Mailing Address - Street 1:8841 COLLEGE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4858
Mailing Address - Country:US
Mailing Address - Phone:239-275-0770
Mailing Address - Fax:239-275-5770
Practice Address - Street 1:8841 COLLEGE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4858
Practice Address - Country:US
Practice Address - Phone:239-275-0770
Practice Address - Fax:239-275-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 6762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA238Medicare UPIN