Organization
FULLER LIFE CHIROPRACTIC CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD FULER D.C. (PRESIDENT)
(678) 432-4755
Entity
Organization
Contact information
Practice address
23 EAST MAIN ST, MANCHESTER, GA 31816
(678) 432-4755
Mailing address
PO BOX 307, MANCHESTER, GA 31816
(678) 432-4755
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
005224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK3398
RIALROAD MEDICARE GROUP#
GA
01
—
GRP3272
MEDICARE GROUP NUMBER
GA
Enumeration date
03/24/2008
Last updated
01/25/2013
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