Provider Demographics
NPI:1053418715
Name:FULLMER, WILLIAM MK (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MK
Last Name:FULLMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:30 APPLETREE CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2932
Mailing Address - Country:US
Mailing Address - Phone:508-697-5336
Mailing Address - Fax:508-697-1599
Practice Address - Street 1:10800 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1554
Practice Address - Country:US
Practice Address - Phone:508-697-5336
Practice Address - Fax:508-697-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD03493111N00000X
MA2173111N00000X
VA0104556486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor