Provider Demographics
NPI:1750676003
Name:FULTS, WILL TRAVIS (DC)
Entity Type:Individual
Prefix:DR
First Name:WILL
Middle Name:TRAVIS
Last Name:FULTS
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 1:4970 W HWY 290 STE 280
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6748
Mailing Address - Country:US
Mailing Address - Phone:512-891-9989
Mailing Address - Fax:
Practice Address - Street 1:4970 W HWY 290 STE 280
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6748
Practice Address - Country:US
Practice Address - Phone:512-891-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor