Provider Demographics
NPI:1750803458
Name:HULL, KEITH (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HULL
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 1:40 GEORGE KARL BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7183
Mailing Address - Country:US
Mailing Address - Phone:716-708-0141
Mailing Address - Fax:
Practice Address - Street 1:40 GEORGE KARL BLVD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-7183
Practice Address - Country:US
Practice Address - Phone:716-218-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor