Individual
KOREN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 W 1ST AVE, COAL VALLEY, IL 61240-9308
(309) 799-7422
Mailing address
401 WALNUT ST, PORT BYRON, IL 61275-9559
(309) 644-9252
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227023901
IL
Other
Enumeration date
03/28/2026
Last updated
03/28/2026
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