Healthcare Provider Details

I. General information

NPI: 1376922989
Provider Name (Legal Business Name): HULL CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BLACK FOREST RD SUITE 4
HULL IA
51239-7411
US

IV. Provider business mailing address

PO BOX 81
SIOUX CENTER IA
51250-0081
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-4838
  • Fax:
Mailing address:
  • Phone: 712-722-4838
  • Fax: 712-722-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007606
License Number StateIA

VIII. Authorized Official

Name: DR. DEREK KOSTERS
Title or Position: PRESIDENT
Credential: D.C
Phone: 712-722-4838