Provider Demographics
NPI:1922464825
Name:FULP SPINAL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:FULP SPINAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-402-7833
Mailing Address - Street 1:114 12TH ST W STE F
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-6976
Mailing Address - Country:US
Mailing Address - Phone:229-402-7833
Mailing Address - Fax:229-472-9055
Practice Address - Street 1:114 12TH ST W STE F
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-6976
Practice Address - Country:US
Practice Address - Phone:229-402-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty