Individual
MARCUS MITCHELL FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC , LMT, MACOM
Contact information
Practice address
300 N WILLSON AVE STE 2003, BOZEMAN, MT 59715-3597
(406) 577-2168
Mailing address
PO BOX 3205, VALDEZ, AK 99686-3205
(907) 255-8413
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
138929
AK
171100000X
Acupuncturist
Primary
MED-ACU-LIC-70143
MT
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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