Organization Active NPI

Hulsebus Rockford Chiropractic

  • Chiropractor
  • Rockford, IL
National Provider Identifier
1104931427
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-3538 Issued in IL
Legal business name
HULSEBUS ROCKFORD CHIROPRACTIC
Practice address
1877 Daimler Rd
Rockford, IL 61112-1005
Phone
(815) 398-3434
Fax
(815) 398-3548
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael J Hulsebus, D.C.
Title
Owner
Phone
(815) 398-3434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038-3538 IL Primary

Addresses

Primary practice location

1877 Daimler Rd
Rockford, IL 61112-1005

Mailing address

1877 Daimler Rd
Rockford, IL 61112-1005
Phone (815) 398-3434

Other identifiers 1

IdentifierTypeStateIssuer
991950OtherILMEDICARE GROUP #

Other names 1

  • Hulsebus Chiropractic Clinic of Rockford Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100118000038 IL Part B Supplier - Clinic/Group Practice 4486796232 Receives reassigned benefits from 4 practitioners
Practice locations: Rockford, IL

National Provider Directory

National Provider Directory

Locations

1877 Daimler Rd
Rockford, IL 61112
Phone (815) 398-3434

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1104931427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1877 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121005",
            "telephone_number": "815-398-3434",
            "fax_number": "815-398-3548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1877 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121005",
            "telephone_number": "815-398-3434",
            "fax_number": "815-398-3548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HULSEBUS ROCKFORD CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "HULSEBUS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-398-3434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-3538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "991950",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hulsebus Chiropractic Clinic of Rockford",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.