Fuller Health Group LLC

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

038010329 Issued in IL

Legal business name

FULLER HEALTH GROUP LLC

Practice address

12 W Maple St
Chicago, IL 60610-4691

Phone

(312) 587-3500

NPI assigned

Dec 8, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Brian Jay Fuller, DC

Title

President

Phone

(708) 705-9494

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1962647792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603030349",
            "telephone_number": "708-705-9494",
            "fax_number": "708-386-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W MAPLE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606104691",
            "telephone_number": "312-587-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-705-9494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "IL",
            "license": "038010329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF ILLINOIS",
            "identifier": "1073556544",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Full Life Centers, LLC
• Full Time Transport LLC
• Amanda Full, DVM, DACVIM
• Dominic Edward Fullenkamp, M.D.
• Fuller Counseling Group LLC
• Alexis Fuller, LCSW
• Alisha Fuller, LPC
• Anna Fuller, APN
• Brittany Anne Fuller
• Davida Dawana Fuller, LCSW

• Nutrition Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Nutrition Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; 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.