Provider Demographics
NPI:1669519229
Name:HULSEY, LORETTA M (DC)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:HULSEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 SW 202ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4802
Mailing Address - Country:US
Mailing Address - Phone:352-472-3555
Mailing Address - Fax:352-472-3555
Practice Address - Street 1:25355 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-4253
Practice Address - Country:US
Practice Address - Phone:352-472-3555
Practice Address - Fax:352-472-3555
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7019111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55381OtherBLUE CROSS BLUE SHIELD
FL55381Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL55381OtherBLUE CROSS BLUE SHIELD