Healthcare Provider Details

I. General information

NPI: 1245402387
Provider Name (Legal Business Name): RICK V HULBERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 N FIVE MILE RD SUITE A
BOISE ID
83713-5215
US

IV. Provider business mailing address

1740 N MILWAUKEE ST SUITE B
BOISE ID
83704-7191
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-9500
  • Fax:
Mailing address:
  • Phone: 208-377-9500
  • Fax: 208-377-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-341
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: