Provider Demographics
NPI:1861420531
Name:HULL, JONATHAN A (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
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 1:2474 HEATHERMOOR PARK DR N
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8233
Mailing Address - Country:US
Mailing Address - Phone:317-243-2392
Mailing Address - Fax:317-244-2032
Practice Address - Street 1:6443 W 10TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-6501
Practice Address - Country:US
Practice Address - Phone:317-243-2392
Practice Address - Fax:317-244-2032
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093755OtherANTHEM BC BS
IN350049570OtherRAILROAD MEDICARE
IN200071230AMedicaid
IN352090464OtherHUMANA/CHOICE CARE NTWK
IN000000093755OtherANTHEM BC BS
IN149220Medicare ID - Type Unspecified