Provider Demographics
NPI:1568599462
Name:FULMORE, RONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:FULMORE
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 1:781 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6835
Mailing Address - Country:US
Mailing Address - Phone:407-339-2888
Mailing Address - Fax:407-831-3085
Practice Address - Street 1:1500 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3716
Practice Address - Country:US
Practice Address - Phone:407-425-6578
Practice Address - Fax:407-872-1165
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70605Medicare ID - Type Unspecified