Provider Demographics
NPI:1346241742
Name:HARTMAN, ERIC RYAN (D C)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RYAN
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7909
Mailing Address - Country:US
Mailing Address - Phone:616-457-1168
Mailing Address - Fax:616-457-1196
Practice Address - Street 1:302 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7909
Practice Address - Country:US
Practice Address - Phone:616-457-1168
Practice Address - Fax:616-457-1196
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3244583Medicaid
MI950G00526OtherBCBSM
MI3244583Medicaid
MIMI2395001Medicare PIN
MI300547265OtherEIN/PH/AETNA/COFINITY/MULTIPLAN