Provider Demographics
NPI:1558371765
Name:HULTEEN, HENRY WILLIAM JR (DC)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WILLIAM
Last Name:HULTEEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4211
Mailing Address - Country:US
Mailing Address - Phone:803-432-1478
Mailing Address - Fax:803-432-4212
Practice Address - Street 1:1007 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4211
Practice Address - Country:US
Practice Address - Phone:803-432-1478
Practice Address - Fax:803-432-4212
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC692111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0692Medicaid
SCCH0692Medicaid