Provider Demographics
NPI:1518927243
Name:HAUPTMAN, GARRET M (DC)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:M
Last Name:HAUPTMAN
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 1:2601 PENNSYLVANIA AVE
Mailing Address - Street 2:UNIT C6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2348
Mailing Address - Country:US
Mailing Address - Phone:215-564-4880
Mailing Address - Fax:215-564-4890
Practice Address - Street 1:2601 PENNSYLVANIA AVE
Practice Address - Street 2:UNIT C6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2348
Practice Address - Country:US
Practice Address - Phone:215-564-4880
Practice Address - Fax:215-564-4890
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054768Medicare ID - Type Unspecified