Provider Demographics
NPI:1174621288
Name:FULCHER, JACLYN (DC)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:FULCHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 K AVE
Mailing Address - Street 2:STE. 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5340
Mailing Address - Country:US
Mailing Address - Phone:972-424-2225
Mailing Address - Fax:972-424-7709
Practice Address - Street 1:2504 K AVE
Practice Address - Street 2:STE. 500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5340
Practice Address - Country:US
Practice Address - Phone:972-424-2225
Practice Address - Fax:972-424-7709
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor