Healthcare Provider Details

I. General information

NPI: 1104931427
Provider Name (Legal Business Name): HULSEBUS ROCKFORD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 DAIMLER RD
ROCKFORD IL
61112-1005
US

IV. Provider business mailing address

1877 DAIMLER RD
ROCKFORD IL
61112-1005
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3434
  • Fax: 815-398-3548
Mailing address:
  • Phone: 815-398-3434
  • Fax: 815-398-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-3538
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL J HULSEBUS
Title or Position: OWNER
Credential: D.C.
Phone: 815-398-3434