Healthcare Provider Details

I. General information

NPI: 1972742450
Provider Name (Legal Business Name): BRIAN JEFFREY HULL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NEIDER AVE STE 105
COEUR D ALENE ID
83815-6007
US

IV. Provider business mailing address

320 E NEIDER AVE STE 103
COEUR D ALENE ID
83815-6007
US

V. Phone/Fax

Practice location:
  • Phone: 208-930-4944
  • Fax: 888-443-4939
Mailing address:
  • Phone: 208-930-4944
  • Fax: 888-443-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1353
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: