Provider Demographics
NPI:1609848043
Name:HULTMAN, CORY BLAINE (DC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:BLAINE
Last Name:HULTMAN
Suffix:
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 1:2611 NE 125TH ST
Mailing Address - Street 2:247
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-367-5090
Mailing Address - Fax:206-367-8634
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:247
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-367-5090
Practice Address - Fax:206-367-8634
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60186618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19363Medicare PIN
ILU70011Medicare UPIN