Provider Demographics
NPI:1588926414
Name:HULSEBUS MACHESNEY PARK CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HULSEBUS MACHESNEY PARK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HULSEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-654-1044
Mailing Address - Street 1:1010 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2518
Mailing Address - Country:US
Mailing Address - Phone:815-654-1044
Mailing Address - Fax:815-639-3529
Practice Address - Street 1:1010 HARLEM RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2518
Practice Address - Country:US
Practice Address - Phone:815-654-1044
Practice Address - Fax:815-639-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty