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General NPI Number Information
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NPI Number | 1568709566
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Entity Type | Organization
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Legal Business Name | TOR TOR INC.
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 5714 W 34TH AVE
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City | AMARILLO
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State | TX
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Zip | 79109-4106
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Country | US
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Telephone | 806-322-1916
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Fax | 806-322-1916
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Provider Business Mailing Address
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Address Line | 8004 MONTICELLO CT
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City | AMARILLO
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State | TX
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Zip | 79119-4969
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Country | US
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Telephone | 806-382-6409
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. STEPHEN FULLER
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Credential | D.C.
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Telephone | 806-322-1916
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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 | 10311
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License Number State | TX
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