Provider Demographics
NPI:1639170954
Name:HULTS, IVAGENE P (DC, CICE)
Entity Type:Individual
Prefix:DR
First Name:IVAGENE
Middle Name:P
Last Name:HULTS
Suffix:
Gender:F
Credentials:DC, CICE
Other - Prefix:DR
Other - First Name:GENIE
Other - Middle Name:
Other - Last Name:HULTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7250 DINGO CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4556
Mailing Address - Country:US
Mailing Address - Phone:702-245-6090
Mailing Address - Fax:702-269-7078
Practice Address - Street 1:2250 E TROPICANA AVE
Practice Address - Street 2:#3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6541
Practice Address - Country:US
Practice Address - Phone:702-245-6090
Practice Address - Fax:702-269-7078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00470111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV865091OtherUSA MANAGED CARE
NVB00470OtherDC LICENSE
NV1006922OtherFOCUS HEALTHCARE MGT.
NV737260OtherFIRSTS HEALTH
NVP-65814852OtherMULTIPLAN, INC.
CA18825OtherDC LICENSE
NV9156671OtherPHCS
NVNVIPH-HCROtherEDI SUBMITTER ID FOR IVA
CA18825OtherDC LICENSE
NV737260OtherFIRSTS HEALTH