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General NPI Number Information
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NPI Number | 1255571360
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Entity Type | Organization
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Legal Business Name | HULBERT CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 353 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5001
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Country | US
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Telephone | 812-330-1234
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Fax | 812-330-1221
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Provider Business Mailing Address
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Address Line | 353 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5001
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Country | US
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Telephone | 812-330-1234
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Fax | 812-330-1221
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. TRAVIS RUSSELL HULBERT
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Credential | DC
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Telephone | 812-330-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 08002421A
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License Number State | IN
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