Provider Demographics
NPI:1689630998
Name:FULTON, CHARLES L (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:FULTON
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 1:8841 COLLEGE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4858
Mailing Address - Country:US
Mailing Address - Phone:239-275-0770
Mailing Address - Fax:239-275-5770
Practice Address - Street 1:8841 COLLEGE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4858
Practice Address - Country:US
Practice Address - Phone:239-275-0770
Practice Address - Fax:239-275-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22993XOtherMEDICARE
FL22993XOtherMEDICARE