Provider Demographics
NPI:1073572699
Name:HARTEY, THOMAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HARTEY
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 1:114 ST VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:570-686-2225
Mailing Address - Fax:570-686-1310
Practice Address - Street 1:114 ST VINCENT DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337
Practice Address - Country:US
Practice Address - Phone:570-686-2225
Practice Address - Fax:570-686-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006028L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015925320002Medicaid
HA883768Medicare ID - Type Unspecified
PA0015925320002Medicaid