Provider Demographics
NPI:1679830574
Name:FULMORE & ASSOCIATES CHIROPRACTIC AND SPINAL INJURY CENTERS, PA
Entity Type:Organization
Organization Name:FULMORE & ASSOCIATES CHIROPRACTIC AND SPINAL INJURY CENTERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULMORE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:407-339-2888
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 1:781 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6835
Practice Address - Country:US
Practice Address - Phone:407-339-2888
Practice Address - Fax:407-831-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70605Medicare PIN