MEDICARE: DR. MICHAEL FULLER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4001	NC

General Provider Information

NPI Number	:	1245461300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FULLER D.C.

Provider Business Mailing Address
First Line	:	1143 KILDAIRE FARM RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-4563
Country	:	US
Telephone Number	:	919-467-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1143 KILDAIRE FARMS RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-4563
Country	:	US
Telephone Number	:	919-467-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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