Provider Demographics
NPI:1790755973
Name:FULKMAN, JOHN WILLIAM III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:FULKMAN
Suffix:III
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 1:380A GREEN WING ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-2331
Mailing Address - Country:US
Mailing Address - Phone:281-334-9300
Mailing Address - Fax:281-334-9301
Practice Address - Street 1:380A GREEN WING ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-2331
Practice Address - Country:US
Practice Address - Phone:281-334-9300
Practice Address - Fax:281-334-9301
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3722Medicare ID - Type Unspecified
TX8A3722Medicare UPIN