DR. KELLY BLAINE FULLERTON (NPI# 1164802633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164802633 |
| Entity Type | Individual |
| Full Name | DR. KELLY BLAINE FULLERTON |
| Other Name | DR. KELLY BLAINE FULLERTON |
| Credential | D.C. |
| Practice Address |
2110 S Coast Hwy Ste A Oceanside CA 92054-6544 |
| Practice Telephone | 7607200000 |
| Practice Fax Number | 7606870017 |
| Mailing Telephone | 7607200000 |
| Mailing Fax Number | 7606870017 |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-06-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 20978 | CA | Chiropractic Providers |
| N | 111NX0100X |
Chiropractor Specialization: Occupational Health |
20978 | CA | Chiropractic Providers |
| Street Address |
2110 S COAST HWY STE A |
| City | OCEANSIDE |
| State | CA |
| Zip Code | 92054-6544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497369987 | Crownview Telehealth Instiute LLC | Community/Behavioral Health | 315 North Clementine Street, Oceanside, CA 92054 | 2020-09-02 |
| 1992353585 | Janell Katherine Dulaney | Student in an Organized Health Care Education/Training Program | 738 S Tremont St, Oceanside, CA 92054 | 2019-08-28 |
| 1295201986 | North County Psychology Apc | Clinical Neuropsychologist | 2204 S. El Camino Real, #305, Oceanside, CA 92054 | 2018-10-19 |
| 1437638947 | Amy Joanne Buckner | Student in an Organized Health Care Education/Training Program | 2204 S El Camino Real Ste 102, Oceanside, CA 92054 | 2018-08-07 |
| 1285112458 | Alique Bedikian | Counselor | 1100 Sportfisher Dr, Oceanside, Oceanside, CA 92054 | 2018-07-31 |
| 1053809244 | Thrive Medical Specialists, A Professional Corporation | Physical Medicine & Rehabilitation | 322 N Nevada St., Oceanside, CA 92054 | 2018-04-24 |
| 1982133377 | Maegan Casanova | Psychologist | 1213 Herby Way, Oceanside, CA 92054 | 2017-06-08 |
| 1588109466 | Ryan Purvis | Counselor | 2812 Oceanside Blvd, Oceanside, CA 92054 | 2016-12-30 |
| 1629512595 | Ahi Vein and Vascular Specialists Inc A Professional Medical Corp | Clinic/Center | 2125 South El Camino Real, Suite 210, Oceanside, CA 92054 | 2016-12-13 |
| 1437531175 | Ginger Burleson | Counselor | 1110 Sportfisher Drive, Oceanside, CA 92054 | 2015-06-18 |
| Find all providers in zip 92054 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922560390 | Angelica Joy Malek | Chiropractor | 2111 S El Camino Real Ste 301, Oceanside, CA 92054-9000 | 2019-04-03 |
| 1689160749 | Emil A Tocci, Dc, PC | Chiropractor | 3091 Lawson Blvd, Oceanside, NY 11572 | 2018-07-02 |
| 1124532619 | Living Better Healthcare, Inc. | Chiropractor | 2216 S El Camino Real Ste 202, Oceanside, CA 92054-6371 | 2017-11-21 |
| 1588103899 | Comprehensive Chiropractic Center | Chiropractor | 2854 Lower Lincoln Ave, Oceanside, NY 11572-2117 | 2017-02-20 |
| 1063894400 | Cordie Lee Williams | Chiropractor | 2216 S El Camino Real Ste 208, Oceanside, CA 92054-6371 | 2015-06-22 |
| 1851637946 | Chc Chiropractic PC | Chiropractor | 2854 Long Beach Rd, Oceanside, NY 11572-2230 | 2012-12-18 |
| 1396018859 | Spineisland for Chiropractic P C | Chiropractor | 118 Henrietta Ave, Oceanside, NY 11572-5226 | 2012-02-14 |
| 1457622276 | Lee Weiner, Dc | Chiropractor | 9a Davison Ave W, Oceanside, NY 11572-2132 | 2012-01-25 |
| 1982939831 | Debroah Star Ladermann | Chiropractor | 379 Rimhurst Ct, Oceanside, CA 92058-7033 | 2009-10-09 |
| 1083802417 | Jessica Amber Walker | Chiropractor | 1012 S Coast Hwy, Suite G, Oceanside, CA 92054-5058 | 2007-10-10 |
| Find all providers in OCEANSIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.