Healthcare Provider Details

I. General information

NPI: 1386958817
Provider Name (Legal Business Name): DAVID A FULGINITI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3378 HARVEST DR
GORDONVILLE PA
17529-9665
US

IV. Provider business mailing address

3378 HARVEST DR
GORDONVILLE PA
17529-9665
US

V. Phone/Fax

Practice location:
  • Phone: 717-768-5410
  • Fax: 717-768-5412
Mailing address:
  • Phone: 717-768-5410
  • Fax: 717-768-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-006942-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: