Individual
MISTY MARIE FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
2801 W NORTHERN AVE, PHOENIX, AZ 85051-6646
(602) 242-7537
(602) 242-4169
Mailing address
2801 W NORTHERN AVE, PHOENIX, AZ 85051-6646
(602) 242-7537
(602) 242-4169
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8252
AZ
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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