MEDICARE: CORY BLAINE HULTMAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	60186618	WA

General Provider Information

NPI Number	:	1609848043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY BLAINE HULTMAN D.C.

Provider Business Mailing Address
First Line	:	2611 NE 125TH ST
Second Line	:	247
City	:	SEATTLE
State	:	WA
Zip	:	98125-4373
Country	:	US
Telephone Number	:	206-367-5090
Fax Number	:	206-367-8634

Provider Business Practice Location Address
First Line	:	2611 NE 125TH ST
Second Line	:	247
City	:	SEATTLE
State	:	WA
Zip	:	98125-4373
Country	:	US
Telephone Number	:	206-367-5090
Fax Number	:	206-367-8634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	04/16/2013

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