Provider Demographics
NPI:1275576472
Name:HARTLEY, ALAN DAVID (PHD, DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:PHD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 LATITUDE LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8124
Mailing Address - Country:US
Mailing Address - Phone:803-831-6500
Mailing Address - Fax:803-831-6383
Practice Address - Street 1:244 LATITUDE LN
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8124
Practice Address - Country:US
Practice Address - Phone:803-831-6500
Practice Address - Fax:803-831-6383
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2361Medicaid
SCGCH347Medicaid
SC84059Medicare UPIN
SCCH2361Medicaid