Provider Demographics
NPI:1588900435
Name:FULTZ, DAVID CHRISTOPHER (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:FULTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 MAIN RD
Mailing Address - Street 2:PO BOX 334
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2340
Mailing Address - Country:US
Mailing Address - Phone:570-477-2778
Mailing Address - Fax:570-477-3572
Practice Address - Street 1:5321 MAIN RD
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2340
Practice Address - Country:US
Practice Address - Phone:570-477-2778
Practice Address - Fax:570-477-3572
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002761629OtherHIGHMARK BLUE SHIELD/FPLIC
PA830982OtherFIRST PRIORITY HEALTH