Provider Demographics
NPI:1538300140
Name:FULKERSON, MARC ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:FULKERSON
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 1:158 BOWLER LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1502
Mailing Address - Country:US
Mailing Address - Phone:443-542-9299
Mailing Address - Fax:
Practice Address - Street 1:13662 OFFICE PL
Practice Address - Street 2:103
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4217
Practice Address - Country:US
Practice Address - Phone:703-878-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor