Provider Demographics
NPI:1689869299
Name:FULLER CLINIC,LLC
Entity Type:Organization
Organization Name:FULLER CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-283-7400
Mailing Address - Street 1:909 W FM 495
Mailing Address - Street 2:STE., 1
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3501
Mailing Address - Country:US
Mailing Address - Phone:956-283-7400
Mailing Address - Fax:956-283-7490
Practice Address - Street 1:909 W FM 495
Practice Address - Street 2:STE., 1
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3501
Practice Address - Country:US
Practice Address - Phone:956-283-7400
Practice Address - Fax:956-283-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty