Provider Demographics
NPI:1245402387
Name:HULBERT, RICK V (DC)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:V
Last Name:HULBERT
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 1:1740 N MILWAUKEE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7191
Mailing Address - Country:US
Mailing Address - Phone:208-377-9500
Mailing Address - Fax:208-377-8449
Practice Address - Street 1:3062 N FIVE MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5215
Practice Address - Country:US
Practice Address - Phone:208-377-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1670920Medicare PIN