| NPI | 1164802633 |
|---|---|
| Professional Name | KELLY BLAINE FULLERTON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 20978) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: CA 20978) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-06-01 |