Provider Demographics
NPI:1891936555
Name:HARTLEY, JENNIFER D (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:HARTLEY
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 1:2757 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4124
Mailing Address - Country:US
Mailing Address - Phone:720-524-3477
Mailing Address - Fax:720-524-3472
Practice Address - Street 1:2757 BRYANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4124
Practice Address - Country:US
Practice Address - Phone:720-524-3477
Practice Address - Fax:720-524-3472
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100575Medicare PIN