Provider Demographics
NPI:1275856882
Name:FULLERTON, BARBARA (DC)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 OVERLOOK LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5058
Mailing Address - Country:US
Mailing Address - Phone:623-535-3694
Mailing Address - Fax:623-535-6669
Practice Address - Street 1:4902 OVERLOOK LN
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5058
Practice Address - Country:US
Practice Address - Phone:623-535-3694
Practice Address - Fax:623-535-6669
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor