Provider Demographics
NPI:1609058957
Name:DR NORMAN E FULLER PC
Entity Type:Organization
Organization Name:DR NORMAN E FULLER PC
Other - Org Name:ALPINE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-376-2475
Mailing Address - Street 1:833 W COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6937
Mailing Address - Country:US
Mailing Address - Phone:907-376-2475
Mailing Address - Fax:907-373-5154
Practice Address - Street 1:833 W COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6937
Practice Address - Country:US
Practice Address - Phone:907-376-2475
Practice Address - Fax:907-373-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0251Medicaid
AKCH0251Medicaid