Provider Demographics
NPI:1407005895
Name:HARTLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HARTLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-205-9601
Mailing Address - Street 1:26302 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4135
Mailing Address - Country:US
Mailing Address - Phone:630-205-9601
Mailing Address - Fax:
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:630-205-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217164Medicare PIN