Structural Disorders of the Spine

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

009494 Issued in PA

Legal business name

STRUCTURAL DISORDERS OF THE SPINE

Practice address

21 North 4TH Street
Harrisburg, PA 17101

Phone

(717) 233-3476

Fax

(717) 796-2409

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jason Michael Fullmer, DCNPI 1417985227

Title

Owner

Phone

(717) 460-3422

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Michael Fullmer, DC

  • Chiropractor
  • Harrisburg, PA
  • NPI 1417985227
  NPD (past) Authorized official

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902853070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 NORTH 4TH STREET",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "17101",
            "telephone_number": "717-233-3476",
            "fax_number": "717-796-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 NORTH 4TH STREET",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "17101",
            "telephone_number": "717-233-3476",
            "fax_number": "717-796-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRUCTURAL DISORDERS OF THE SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-460-3422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "009494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "FU1813015",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50058252",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connie Strickler
• Trey David Stroble
• Angela Strock, DPT
• Gerald Strohecker, PHARMD
• Jeffrey A Stroup, CRNP, DNP
• Edward O. Stuber, MA, ICAADC
• Brian Stwalley
• Joseph F Stynchula, DC
• Selma Su, M.D.
• Substance Abuse Services, Inc. (The RASE Project)

• Chiropractor in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.