Healthcare Provider Details

I. General information

NPI: 1639170954
Provider Name (Legal Business Name): IVAGENE P. HULTS DC, CICE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: GENIE HULTS DC

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 E TROPICANA AVE #3
LAS VEGAS NV
89119-6541
US

IV. Provider business mailing address

7250 DINGO CT
LAS VEGAS NV
89119-4556
US

V. Phone/Fax

Practice location:
  • Phone: 702-245-6090
  • Fax: 702-269-7078
Mailing address:
  • Phone: 702-245-6090
  • Fax: 702-269-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberB00470
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: