Provider Demographics
NPI:1306051222
Name:FULLER, NANCY C (D C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:FULLER
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:C
Other - Last Name:CALLEGARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D C
Mailing Address - Street 1:3 CANADA ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-1322
Mailing Address - Country:US
Mailing Address - Phone:802-868-7725
Mailing Address - Fax:802-868-3703
Practice Address - Street 1:104 ROBIN HOOD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-8003
Practice Address - Country:US
Practice Address - Phone:802-868-7725
Practice Address - Fax:802-868-3703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012108Medicaid
VTFUVN3847Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID