Provider Demographics
NPI:1265495519
Name:FULTON, RONALD HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HAROLD
Last Name:FULTON
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 1:639 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2220
Mailing Address - Country:US
Mailing Address - Phone:206-246-5600
Mailing Address - Fax:206-246-4019
Practice Address - Street 1:639 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2220
Practice Address - Country:US
Practice Address - Phone:206-246-5600
Practice Address - Fax:206-246-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAFU0349OtherREGENCE BLUE SHIELD
WA0005580085OtherAETNA INSURANCE
WA156051100000OtherPREMERA BLUE CROSS
WA0016978OtherLABOR & INDUSTRIES