Tasha Marie Fuller, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

013201 Issued in NY

Practice address

47 Virginia St
Waterloo, NY 13165-1444

Phone

(315) 664-2216

NPI assigned

Dec 6, 2018

Last updated

Mar 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584489600000",
    "number": "1619448370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 E ELISHA ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651402",
            "telephone_number": "315-664-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 VIRGINIA ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651444",
            "telephone_number": "315-664-2216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9-27 East Main Street",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "NY",
            "postal_code": "13165",
            "country_code": "US",
            "telephone_number": "315-664-2216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TASHA",
        "middle_name": "MARIE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-06",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "013201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Waterloo, NY
• Providers in Waterloo, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.