Provider Demographics
NPI:1447212832
Name:HARTEY, EDWARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:HARTEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336
Mailing Address - Country:US
Mailing Address - Phone:570-491-2225
Mailing Address - Fax:570-491-4539
Practice Address - Street 1:600 PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336
Practice Address - Country:US
Practice Address - Phone:570-491-2225
Practice Address - Fax:570-491-4539
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002930L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010025290002Medicaid
T27168Medicare UPIN
PA028068Medicare ID - Type Unspecified