Individual
ROGER R FULLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
128 W BOSTON, CHANDLER, AZ 85225-7874
(480) 963-4473
(480) 963-4513
Mailing address
128 W BOSTON, CHANDLER, AZ 85225-7874
(480) 963-4473
(480) 963-4513
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3831
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0944910
BCBSAZ
AZ
01
—
P00112110
UN HEALTHCARE RAILROAD RE
—
Enumeration date
11/28/2006
Last updated
07/08/2007
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