Healthcare Provider Details

I. General information

NPI: 1053463422
Provider Name (Legal Business Name): RUSSELL D. HULSE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 HIGHWAY 31 SW
HARTSELLE AL
35640-2872
US

IV. Provider business mailing address

897 HIGHWAY 31 SW
HARTSELLE AL
35640-2872
US

V. Phone/Fax

Practice location:
  • Phone: 256-751-0033
  • Fax: 256-751-0037
Mailing address:
  • Phone: 256-751-0033
  • Fax: 256-751-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1636
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: