Provider Demographics
NPI:1366558371
Name:FULCHER, GARLAND G (DC)
Entity type:Individual
Prefix:
First Name:GARLAND
Middle Name:G
Last Name:FULCHER
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 1:2504 AVENUE K
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:214-424-2225
Mailing Address - Fax:972-424-7709
Practice Address - Street 1:2504 AVENUE K
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:2006-08-22
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R9800OtherB LUE CROSS BLUE SHIELD
TXV00212Medicare UPIN
TX8R9800OtherB LUE CROSS BLUE SHIELD