Provider Demographics
NPI:1609024124
Name:GARRY T. FULLER, D.C., PC
Entity Type:Organization
Organization Name:GARRY T. FULLER, D.C., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-852-8885
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-0459
Mailing Address - Country:US
Mailing Address - Phone:317-852-8885
Mailing Address - Fax:317-534-3444
Practice Address - Street 1:515 N GREEN ST STE 100
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2115
Practice Address - Country:US
Practice Address - Phone:317-852-8885
Practice Address - Fax:317-852-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty