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Organization
HEALTHPORT P.A.
Active
Organization
HEALTHPORT P.A.
Active
Other names
PAIN RECOVERY CENTER OF TYLER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH FULTS D.O. (PRESIDENT)
(903) 526-5000
Entity
Organization
Contact information
Practice address
4295 KINSEY DR, TYLER, TX 75703-1004
(903) 526-5000
(903) 526-5006
Mailing address
4295 KINSEY DR, TYLER, TX 75703-1004
(903) 526-5000
(903) 526-5006
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
08/15/2008
Last updated
01/07/2013
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