Provider Demographics
NPI:1588707095
Name:DEAN A. HULSING PC
Entity type:Organization
Organization Name:DEAN A. HULSING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HULSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-379-2088
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:IL
Mailing Address - Zip Code:61376-0268
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 W. NORTH STREET
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:IL
Practice Address - Zip Code:61376
Practice Address - Country:US
Practice Address - Phone:815-379-2088
Practice Address - Fax:815-379-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00632016OtherBLUE CROSS BLUE SHIELD
IL213239Medicare ID - Type Unspecified
IL00632016OtherBLUE CROSS BLUE SHIELD