Provider Demographics
NPI:1811252901
Name:FULMER CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:FULMER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-726-2668
Mailing Address - Street 1:PO BOX 6024
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-1024
Mailing Address - Country:US
Mailing Address - Phone:423-726-2668
Mailing Address - Fax:423-726-2667
Practice Address - Street 1:150 CLINIC DR STE C
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2254
Practice Address - Country:US
Practice Address - Phone:423-726-2668
Practice Address - Fax:423-726-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002577111N00000X
MS1206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty