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Organization
STRUCTURAL DISORDERS OF THE SPINE
Active
Organization
STRUCTURAL DISORDERS OF THE SPINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON MICHAEL FULLMER DC (OWNER)
(717) 460-3422
Entity
Organization
Contact information
Practice address
21 NORTH 4TH STREET, HARRISBURG, PA 17101
(717) 233-3476
(717) 796-2409
Mailing address
21 NORTH 4TH STREET, HARRISBURG, PA 17101
(717) 233-3476
(717) 796-2409
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
009494
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50058252
CAPITAL BLUE CROSS
PA
01
—
FU1813015
HIGHMARK
PA
Enumeration date
05/27/2006
Last updated
08/22/2020
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