Individual provider Active NPI

John T Fulp, D.C.

  • Chiropractor
  • Grand Forks, ND
National Provider Identifier
1003814484
Registry record updated Sep 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
566 Issued in ND
Practice address
2840 19TH Ave S
Grand Forks, ND 58201-5957
Phone
(701) 772-2670
Fax
(701) 772-2706
NPI assigned
Jul 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 566 ND Primary

Addresses

Primary practice location

2840 19TH Ave S
Grand Forks, ND 58201-5957

Mailing address

2840 19TH Ave S
Grand Forks, ND 58201-5957
Phone (701) 772-2670

Other identifiers 7

IdentifierTypeStateIssuer
013490OtherNDBC/ND PROVIDER NUMBER
18198MedicaidND
N13490OtherNDMEDICARE ID-PIN
1003950023OtherNDNPI GROUP NUMBER
N70688OtherNDMEDICARE GROUP NUMBER
1003814484OtherNDNPI
675-001OtherNDBC/BS ND CLINIC NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101108001479 ND Practitioner - Chiropractic 4981899630 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advance Chiropractic Center PLLCGroup PAC ID 5890047575, 2 clinicians

Practice addresses (Care Compare)

2840 19TH Ave S
Grand Forks, ND 58201-5957
Phone (701) 772-2670

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
566NDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Chiropractic Center PLLC Chiropractor CurrentSince Sep 1, 2018 Accepting new patients

Locations

2840 19th Ave S
Grand Forks, ND 58201
Phone (701) 772-2670

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1003814484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 19TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015957",
            "telephone_number": "701-772-2670",
            "fax_number": "701-772-2706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 19TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015957",
            "telephone_number": "701-772-2670",
            "fax_number": "701-772-2706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULP",
        "first_name": "JOHN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/ND PROVIDER NUMBER",
            "identifier": "013490",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18198",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-PIN",
            "identifier": "N13490",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP NUMBER",
            "identifier": "1003950023",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "N70688",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1003814484",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS ND CLINIC NUMBER",
            "identifier": "675-001",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.