Provider Demographics
NPI:1043313612
Name:HULETT, ELLEN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:HULETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3657
Mailing Address - Street 2:
Mailing Address - City:WAQUOIT
Mailing Address - State:MA
Mailing Address - Zip Code:02536-3657
Mailing Address - Country:US
Mailing Address - Phone:508-457-4400
Mailing Address - Fax:508-457-4700
Practice Address - Street 1:446 WAQUOIT HWY
Practice Address - Street 2:
Practice Address - City:WAQUOIT
Practice Address - State:MA
Practice Address - Zip Code:02536-3657
Practice Address - Country:US
Practice Address - Phone:508-457-4400
Practice Address - Fax:508-457-4700
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39524OtherGROUP # BCBS MA
351185OtherHARVARD PILGRIM
MAY36224OtherINDIVIDUAL BCBS MA
001739OtherTUFTS
351185OtherHARVARD PILGRIM
U44173Medicare UPIN