Individual
STACY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
300 W 80TH PL STE A, MERRILLVILLE, IN 46410
(219) 588-3476
Mailing address
2406 NOTTINGHAM DR, VALPARAISO, IN 46383-9181
(219) 588-3476
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002869A
IN
Other
Enumeration date
01/06/2016
Last updated
04/11/2019
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