Provider Demographics
NPI:1093397796
Name:HULTMAN LAKE ENTERPRISES
Entity Type:Organization
Organization Name:HULTMAN LAKE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-629-5288
Mailing Address - Street 1:805 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1660
Mailing Address - Country:US
Mailing Address - Phone:320-629-5288
Mailing Address - Fax:
Practice Address - Street 1:805 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1660
Practice Address - Country:US
Practice Address - Phone:320-629-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health