Provider Demographics
NPI:1134215577
Name:FULKERSON, ADAM THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THOMAS
Last Name:FULKERSON
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 1:1606 N DIXIE HWY
Mailing Address - Street 2:STE 111
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5565
Mailing Address - Country:US
Mailing Address - Phone:270-234-8880
Mailing Address - Fax:270-234-1343
Practice Address - Street 1:1606 N DIXIE HWY
Practice Address - Street 2:STE 111
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5565
Practice Address - Country:US
Practice Address - Phone:270-234-8880
Practice Address - Fax:270-234-1343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003002Medicaid
KY00687001Medicare PIN