Provider Demographics
NPI:1275640096
Name:BRUCE A HARTLE DDS DC CO
Entity Type:Organization
Organization Name:BRUCE A HARTLE DDS DC CO
Other - Org Name:SPRINGBORO CHIROPRACTIC & DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-748-0940
Mailing Address - Street 1:335 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9557
Mailing Address - Country:US
Mailing Address - Phone:937-748-0940
Mailing Address - Fax:937-748-1666
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9557
Practice Address - Country:US
Practice Address - Phone:937-748-0940
Practice Address - Fax:937-748-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1228111N00000X
OH144971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0608361Medicare ID - Type Unspecified