Healthcare Provider Details

I. General information

NPI: 1184782559
Provider Name (Legal Business Name): RICHARD EUGENE HULSE JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 E 38TH ST
ERIE PA
16504-1843
US

IV. Provider business mailing address

1009 E 38TH ST
ERIE PA
16504-1843
US

V. Phone/Fax

Practice location:
  • Phone: 814-824-6442
  • Fax: 814-824-4007
Mailing address:
  • Phone: 814-824-6442
  • Fax: 814-824-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005135L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: