NPIMap

Organization Active NPI

Fuller Health Group SC

  • Chiropractor
  • Oak Park, IL
National Provider Identifier
1689806358
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
FULLER HEALTH GROUP SC
Practice address
1010 Lake St Ste 400
Oak Park, IL 60301-1135
Phone
(312) 801-0318
Fax
(708) 221-7108
NPI assigned
Aug 14, 2009
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Dr. Brian Jay Fuller, DCNPI 1073556544
Title
Chiropractic Physician
Phone
(708) 705-9494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

1010 Lake St Ste 400
Oak Park, IL 60301-1135

Mailing address

1010 Lake St Ste 400
Oak Park, IL 60301-1135
Phone (312) 801-0318

Other names 1

  • Fuller Health Group PC Former legal business name

National Provider Directory

National Provider Directory

Locations

910 W Van Buren St
Ste 419
Chicago, IL 60607

1010 Lake St
Ste 400
Oak Park, IL 60301
Phone (312) 801-0318

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1689806358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 400",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011135",
            "telephone_number": "312-801-0318",
            "fax_number": "708-221-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST STE 400",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011135",
            "telephone_number": "312-801-0318",
            "fax_number": "708-221-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER HEALTH GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-14",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CHIROPRACTIC PHYSICIAN",
        "authorized_official_telephone_number": "708-705-9494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fuller Health Group PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Fuller Health Group PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.

Verify at the official NPI Registry.