Provider Demographics
NPI:1538217849
Name:FULANOVICH, CHARLES J (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:FULANOVICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1009
Mailing Address - Country:US
Mailing Address - Phone:650-328-2100
Mailing Address - Fax:650-328-2104
Practice Address - Street 1:1691 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1009
Practice Address - Country:US
Practice Address - Phone:650-328-2100
Practice Address - Fax:650-328-2104
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04407Medicare UPIN
CADC0115810Medicare ID - Type Unspecified