Provider Demographics
NPI:1689681280
Name:HARTLAND CHIROPRACTIC HEALTH CARE
Entity Type:Organization
Organization Name:HARTLAND CHIROPRACTIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHAWHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-367-0606
Mailing Address - Street 1:N50W34768 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKAUCHEE
Mailing Address - State:WI
Mailing Address - Zip Code:53069-9750
Mailing Address - Country:US
Mailing Address - Phone:262-367-0606
Mailing Address - Fax:262-367-0609
Practice Address - Street 1:N50W34768 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:NASHTOAH
Practice Address - State:WI
Practice Address - Zip Code:53069-9750
Practice Address - Country:US
Practice Address - Phone:262-367-0606
Practice Address - Fax:262-367-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty