Provider Demographics
NPI:1508168360
Name:BOOHER FULTON, JANETTE L (DC)
Entity Type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:L
Last Name:BOOHER FULTON
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 1:4966 SHADOWFALLS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4144
Mailing Address - Country:US
Mailing Address - Phone:925-354-5254
Mailing Address - Fax:
Practice Address - Street 1:4966 SHADOWFALLS DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4144
Practice Address - Country:US
Practice Address - Phone:925-354-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor