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NPI Code Detail

MEDICARE: DR. ZACKARY CUSATI FULKS DC

MEDICARE: DR. ZACKARY CUSATI FULKS DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC36546CA

General Provider Information

NPI Number : 1407562531
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ZACKARY CUSATI FULKS DC
Provider Business Mailing Address
First Line : 2520 NORTHSIDE DR APT 214
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-2794
Country : US
Telephone Number : 925-451-9375
Fax Number :
Provider Business Practice Location Address
First Line : 10039 VINE ST
Second Line :
City : LAKESIDE
State : CA
Zip : 92040-3120
Country : US
Telephone Number : 833-867-4642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2023
Last Update Date : 01/23/2023

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