Active NPI
Kim Kevin Fuller, D.C.
- Sports Physician Chiropractor
- Chesapeake, VA
National Provider Identifier
1063421147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 0104000403
- Practice address
- 106 Wimbledon SQ
Chesapeake, VA 23320-4931 - Phone
- (757) 436-1037
- Fax
- (757) 547-4031
- NPI assigned
- Aug 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 0104000403 | VA | Primary |
Addresses
Primary practice location
106 Wimbledon SQ
Chesapeake, VA 23320-4931
Mailing address
449 Broad Bend Cir
Chesapeake, VA 23320-9292
Phone (757) 436-3473
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060222000840 | VA | Practitioner - Chiropractic | 0547276990 | Practice locations: Chesapeake, VA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353456000000",
"number": "1063421147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "449 BROAD BEND CIR",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233209292",
"telephone_number": "757-436-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 WIMBLEDON SQ",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233204931",
"telephone_number": "757-436-1037",
"fax_number": "757-547-4031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "KIM",
"middle_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-06",
"last_updated": "2012-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "VA",
"license": "0104000403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.