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General NPI Number Information
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NPI Number | 1083891428
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Entity Type | Organization
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Legal Business Name | HEARTLAND FAMILY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 1606 N DIXIE HWY STE 111
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5572
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Country | US
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Telephone | 270-234-8880
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Fax | 270-234-1343
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Provider Business Mailing Address
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Address Line | 1606 N DIXIE HWY STE 111
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-5565
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Country | US
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Telephone | 270-234-8880
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Fax | 270-234-1343
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Authorized Official
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Title or Position | OWNER
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Name | ADAM THOMAS FULKERSON
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Credential | D.C.
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Telephone | 270-234-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4563
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License Number State | KY
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