Provider Demographics
NPI:1922509967
Name:BENJAMIN P HARTMAN DC LLC
Entity Type:Organization
Organization Name:BENJAMIN P HARTMAN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-693-6424
Mailing Address - Street 1:12300 SINGLETREE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7964
Mailing Address - Country:US
Mailing Address - Phone:952-913-3733
Mailing Address - Fax:
Practice Address - Street 1:12300 SINGLETREE LN STE 200
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7964
Practice Address - Country:US
Practice Address - Phone:952-913-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty