Provider Demographics
NPI:1801875760
Name:FULLER, JAMI DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMI
Middle Name:DAWN
Last Name:FULLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S DELAWARE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1548
Mailing Address - Country:US
Mailing Address - Phone:641-342-3018
Mailing Address - Fax:
Practice Address - Street 1:322 S DELAWARE ST
Practice Address - Street 2:STE. 100
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1548
Practice Address - Country:US
Practice Address - Phone:641-342-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1231688Medicaid
IAU86471Medicare UPIN