Individual
KASSY JO FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2006 PROGRESS BLVD, ANTIGO, WI 54409-2475
(715) 623-5481
Mailing address
2006 PROGRESS BLVD, ANTIGO, WI 54409-2475
(715) 623-5481
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5664-12
WI
111N00000X
Chiropractor
60892858
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60892858
CHIROPRACTIC LICENSE
WA
Enumeration date
01/02/2019
Last updated
05/07/2024
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