Provider Demographics
NPI:1235557299
Name:HARTING, DERYK A (DC)
Entity Type:Individual
Prefix:DR
First Name:DERYK
Middle Name:A
Last Name:HARTING
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 1:6540 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1312
Mailing Address - Country:US
Mailing Address - Phone:570-404-0661
Mailing Address - Fax:
Practice Address - Street 1:7405 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1808
Practice Address - Country:US
Practice Address - Phone:941-822-8990
Practice Address - Fax:941-822-8992
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor