Provider Demographics
NPI:1992770531
Name:FULLER, JOSEPH ALLAN (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLAN
Last Name:FULLER
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 1:631 LOMBARD RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9054
Mailing Address - Country:US
Mailing Address - Phone:717-840-0888
Mailing Address - Fax:717-840-4369
Practice Address - Street 1:631 LOMBARD RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9054
Practice Address - Country:US
Practice Address - Phone:717-840-0888
Practice Address - Fax:717-840-4369
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002379-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFU88721Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAT28385Medicare UPIN