Provider Demographics
NPI:1740728468
Name:FULMER, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FULMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5093 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JENNERS
Mailing Address - State:PA
Mailing Address - Zip Code:15546-9606
Mailing Address - Country:US
Mailing Address - Phone:814-629-5581
Mailing Address - Fax:
Practice Address - Street 1:5093 FRONT ST
Practice Address - Street 2:
Practice Address - City:JENNERS
Practice Address - State:PA
Practice Address - Zip Code:15546-9606
Practice Address - Country:US
Practice Address - Phone:814-629-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007084L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor