Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 566 | ND |
NPI | 1003814484 |
---|---|
Provider Name | Dr. John T Fulp |
First Address | Grand Forks, ND 58201-5957 |
Second Address | Grand Forks, ND 58201-5957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013490 | BC/ND PROVIDER NUMBER (01) | ND |
1003814484 | NPI (01) | ND |
1003950023 | NPI GROUP NUMBER (01) | ND |
18198 | (05) | ND |
675-001 | BC/BS ND CLINIC NUMBER (01) | ND |
N13490 | MEDICARE ID-PIN (01) | ND |
N70688 | MEDICARE GROUP NUMBER (01) | ND |