Provider Demographics
NPI:1639287931
Name:HARTLE, REBECCA L (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:HARTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9557
Mailing Address - Country:US
Mailing Address - Phone:937-748-0940
Mailing Address - Fax:937-748-1666
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9557
Practice Address - Country:US
Practice Address - Phone:937-748-0940
Practice Address - Fax:937-748-1666
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0608361Medicare ID - Type Unspecified