Individual
DR. REGGIE STANLEY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4027 37TH ST NW, MAPLE LAKE, MN 55358-3422
(612) 423-3158
Mailing address
4201 SUNSET DR APT 201, SPRING PARK, MN 55384-4512
(612) 423-3158
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5014
MN
Other
Enumeration date
09/05/2007
Last updated
06/11/2008
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