Provider Demographics
NPI:1972045672
Name:HARDY, DANE
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROUTE 130 S
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2845
Mailing Address - Country:US
Mailing Address - Phone:856-314-8922
Mailing Address - Fax:856-389-5660
Practice Address - Street 1:101 ROUTE 130 S
Practice Address - Street 2:SUITE 10
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-2845
Practice Address - Country:US
Practice Address - Phone:856-314-8922
Practice Address - Fax:856-389-5660
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00738000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor