=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649269200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DAVID FULKERSON DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2005
-----------------------------------------------------
Last Update Date | 10/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 N ARMSTRONG AVE
-----------------------------------------------------
City | TULIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79088-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-995-4699
-----------------------------------------------------
Fax | 806-995-4706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 283
-----------------------------------------------------
City | TULIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79088-0283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-995-4699
-----------------------------------------------------
Fax | 806-995-4706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9985
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------