Provider Demographics
NPI:1265201495
Name:FULLEN, SABRINA RANEE LACALLE (DC)
Entity type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:RANEE LACALLE
Last Name:FULLEN
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 1:818 SE 47TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9793
Mailing Address - Country:US
Mailing Address - Phone:392-414-8447
Mailing Address - Fax:
Practice Address - Street 1:818 SE 47TH ST # 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9793
Practice Address - Country:US
Practice Address - Phone:392-414-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor