Active NPI
Matthew Ryan Fuller, DC, LMT
- Chiropractor
- Liverpool, NY
National Provider Identifier
1285307090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 013343
- Practice address
- 4225 Long Branch Rd
Liverpool, NY 13090-3201 - Phone
- (315) 515-0111
- NPI assigned
- Jul 28, 2021
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 013343 | NY | Primary |
Addresses
Primary practice location
4225 Long Branch Rd
Liverpool, NY 13090-3201
Mailing address
80 E Bayard St
Seneca Falls, NY 13148-1626
Phone (315) 577-2028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013343 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627430400000",
"number": "1285307090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 E BAYARD ST",
"city": "SENECA FALLS",
"state": "NY",
"postal_code": "131481626",
"telephone_number": "315-577-2028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4225 LONG BRANCH RD",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130903201",
"telephone_number": "315-515-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "MATTHEW",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "DC, LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-28",
"last_updated": "2021-07-28",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "NY",
"license": "013343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.