Healthcare Provider Details

I. General information

NPI: 1083247852
Provider Name (Legal Business Name): THOMAS JOHN HULM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 N 3RD ST STE 301
PHOENIX AZ
85012-2035
US

IV. Provider business mailing address

3724 N 3RD ST STE 301
PHOENIX AZ
85012-2035
US

V. Phone/Fax

Practice location:
  • Phone: 602-619-4509
  • Fax: 480-404-9649
Mailing address:
  • Phone: 602-619-4509
  • Fax: 480-404-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8896
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: