Provider Demographics
NPI:1912862350
Name:FULFILLMENT CHIROPRACTIC, INC
Entity type:Organization
Organization Name:FULFILLMENT CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-694-4831
Mailing Address - Street 1:900 GULF BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:INDIAN ROCKS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2726
Mailing Address - Country:US
Mailing Address - Phone:215-694-4831
Mailing Address - Fax:
Practice Address - Street 1:3901 MARY ELIZA TRCE NW STE 201
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1096
Practice Address - Country:US
Practice Address - Phone:215-694-4831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-18
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty