MEDICARE: FULFILLMENT CHIROPRACTIC, LLC

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

General Provider Information

NPI Number	:	1912862350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULFILLMENT CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1925 VAUGHN RD NW STE 220
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-4566
Country	:	US
Telephone Number	:	215-694-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 MARY ELIZA TRCE NW STE 201
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1096
Country	:	US
Telephone Number	:	215-694-4831
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT WILLIS MCCORMICK
Credential	:	DC
Telephone Number	:	215-694-4831

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	04/14/2026

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