Provider Demographics
NPI:1285215194
Name:HARTZOG CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HARTZOG CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARTZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-671-0538
Mailing Address - Street 1:7245 BARNWELL RD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-6055
Mailing Address - Country:US
Mailing Address - Phone:803-671-0538
Mailing Address - Fax:
Practice Address - Street 1:7245 BARNWELL RD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-6055
Practice Address - Country:US
Practice Address - Phone:803-671-0538
Practice Address - Fax:800-460-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1134110869OtherDR. KENDALL D. HARTZOG