Provider Demographics
NPI:1972785418
Name:JAMES P. HULSEBUS
Entity Type:Organization
Organization Name:JAMES P. HULSEBUS
Other - Org Name:HULSEBUS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HULSEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-654-1044
Mailing Address - Street 1:1010 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2518
Mailing Address - Country:US
Mailing Address - Phone:815-654-1044
Mailing Address - Fax:815-639-3529
Practice Address - Street 1:1010 HARLEM RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2518
Practice Address - Country:US
Practice Address - Phone:815-654-1044
Practice Address - Fax:815-639-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210554Medicare PIN