# FULLER HEALTH GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962647792
- **Authorized official:** DR. BRIAN JAY FULLER DC (PRESIDENT)
- **Authorized official phone:** (708) 705-9494

## Contact information

- **Practice address:** 12 W MAPLE ST, CHICAGO, IL 60610-4691
- **Practice address phone:** (312) 587-3500
- **Mailing address:** PO BOX 349, OAK PARK, IL 60303-0349
- **Mailing address phone:** (708) 705-9494
- **Mailing address fax:** (708) 386-2768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | 038010329 | IL | Yes |

## Other

- **Enumeration date:** 12/08/2008
- **Last updated:** 12/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1073556544 | BLUE CROSS AND BLUE SHIELD OF ILLINOIS | IL |