Provider Demographics
NPI:1457599342
Name:HULSEBUS, RYAN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:HULSEBUS
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 1:1010 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
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor