Individual
JEFFREY C FULTZ
Active
Individual
JEFFREY C FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC PT
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
857
VA
225100000X
Physical Therapist
1694
NM
225100000X
Physical Therapist
Primary
2639
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29783739
—
CO
05
—
446551
—
AZ
05
—
93438061
—
NM
Enumeration date
12/08/2005
Last updated
08/14/2013
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