Provider Demographics
NPI:1922172493
Name:HAERTEL, STEVEN CARL (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CARL
Last Name:HAERTEL
Suffix:
Gender:M
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738
Mailing Address - Country:US
Mailing Address - Phone:989-275-9029
Mailing Address - Fax:989-275-9029
Practice Address - Street 1:406 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-275-9029
Practice Address - Fax:989-275-9029
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOG25007OtherBLUE CROSS BLUE SHIELD
MIOG25007OtherBLUE CROSS BLUE SHIELD