Provider Demographics
NPI:1972875276
Name:HARTMAN CHIROPRACTIC & REHABILITATION, INC,
Entity Type:Organization
Organization Name:HARTMAN CHIROPRACTIC & REHABILITATION, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-564-6672
Mailing Address - Street 1:1205 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1104
Mailing Address - Country:US
Mailing Address - Phone:920-564-6672
Mailing Address - Fax:920-564-6673
Practice Address - Street 1:1205 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1104
Practice Address - Country:US
Practice Address - Phone:920-564-6672
Practice Address - Fax:920-564-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3503-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38909000Medicaid
WI38909000Medicaid
WI000035436Medicare PIN