Provider Demographics
NPI:1104931427
Name:HULSEBUS ROCKFORD CHIROPRACTIC
Entity type:Organization
Organization Name:HULSEBUS ROCKFORD CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HULSEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-398-3434
Mailing Address - Street 1:1877 DAIMLER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1005
Mailing Address - Country:US
Mailing Address - Phone:815-398-3434
Mailing Address - Fax:815-398-3548
Practice Address - Street 1:1877 DAIMLER RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1005
Practice Address - Country:US
Practice Address - Phone:815-398-3434
Practice Address - Fax:815-398-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-3538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL991950OtherMEDICARE GROUP #