Healthcare Provider Details

I. General information

NPI: 1912862350
Provider Name (Legal Business Name): FULFILLMENT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MARY ELIZA TRCE NW STE 201
MARIETTA GA
30064-1096
US

IV. Provider business mailing address

900 GULF BLVD APT 202
INDIAN ROCKS BEACH FL
33785-2726
US

V. Phone/Fax

Practice location:
  • Phone: 215-694-4831
  • Fax:
Mailing address:
  • Phone: 215-694-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOT WILLIS MCCORMICK
Title or Position: PRESIDENT
Credential: DC
Phone: 215-694-4831