Healthcare Provider Details

I. General information

NPI: 1588926414
Provider Name (Legal Business Name): HULSEBUS MACHESNEY PARK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HARLEM RD
MACHESNEY PARK IL
61115-2518
US

IV. Provider business mailing address

1010 HARLEM RD
MACHESNEY PARK IL
61115-2518
US

V. Phone/Fax

Practice location:
  • Phone: 815-654-1044
  • Fax: 815-639-3529
Mailing address:
  • Phone: 815-654-1044
  • Fax: 815-639-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES P HULSEBUS
Title or Position: DIRECTOR
Credential: DC
Phone: 815-654-1044