Provider Demographics
NPI:1669654356
Name:HARTZELL FAMILY CHIROPRACTIC, P.L.C.
Entity Type:Organization
Organization Name:HARTZELL FAMILY CHIROPRACTIC, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-226-4404
Mailing Address - Street 1:509 ANSBOROUGH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-2139
Mailing Address - Country:US
Mailing Address - Phone:319-226-4404
Mailing Address - Fax:319-226-4406
Practice Address - Street 1:509 ANSBOROUGH AVE
Practice Address - Street 2:STE A
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-2139
Practice Address - Country:US
Practice Address - Phone:319-226-4404
Practice Address - Fax:319-226-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0486209Medicaid
IAI17438OtherMEDICARE ID-PIN
IAV09100Medicare UPIN
IAI17438Medicare PIN