Healthcare Provider Details

I. General information

NPI: 1043433162
Provider Name (Legal Business Name): HULSEBUS AND GEHLSEN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 TERRA WEST DR
FREEPORT IL
61032-4536
US

IV. Provider business mailing address

630 TERRA WEST DR
FREEPORT IL
61032-4536
US

V. Phone/Fax

Practice location:
  • Phone: 815-235-7858
  • Fax: 815-235-7913
Mailing address:
  • Phone: 815-235-7858
  • Fax: 815-235-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number060005547
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFREY P GEHLSEN
Title or Position: VICE PRESIDENT DIRECTOR
Credential: D.C.
Phone: 815-235-7858