Provider Demographics
NPI:1205026176
Name:HART CARE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:HART CARE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-324-2225
Mailing Address - Street 1:300 W MAIN ST
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1561
Mailing Address - Country:US
Mailing Address - Phone:537-324-2225
Mailing Address - Fax:537-324-6250
Practice Address - Street 1:300 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1561
Practice Address - Country:US
Practice Address - Phone:573-324-2225
Practice Address - Fax:573-324-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCE005241OtherWORKERS COMP
22424OtherBLUE CHOICE
22424OtherBLUECROSS BLUESHIELD
T43528OtherMEDICARE DME
178192OtherPPO/HMO
5227583OtherAETNA
MO4450040OtherUNITED HEALTHCARE
MOCE005241OtherWORKERS COMP