Provider Demographics
NPI:1013973361
Name:HARTMAN, BOB G (DC)
Entity Type:Individual
Prefix:MR
First Name:BOB
Middle Name:G
Last Name:HARTMAN
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 1:816 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4002
Mailing Address - Country:US
Mailing Address - Phone:423-639-1431
Mailing Address - Fax:423-639-0827
Practice Address - Street 1:816 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4002
Practice Address - Country:US
Practice Address - Phone:423-639-1431
Practice Address - Fax:423-639-0827
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC82111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11475OtherAMERICAN WHOLEHEALTH
TN3670838Medicaid
TN4025016OtherBCBST
TN4025016OtherBCBST
3670838Medicare ID - Type Unspecified