Provider Demographics
NPI:1609040468
Name:HARTUNG, DAN (CPO)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:HARTUNG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4613
Mailing Address - Country:US
Mailing Address - Phone:615-461-8557
Mailing Address - Fax:615-461-8581
Practice Address - Street 1:1406 E BROADWAY
Practice Address - Street 2:SUITE D
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4613
Practice Address - Country:US
Practice Address - Phone:615-461-8557
Practice Address - Fax:615-461-8581
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNORT0000000159OtherPROFESSIONAL LICENSE