Provider Demographics
NPI:1023483617
Name:HARTMAN, TIMOTHY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
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 1:6290 JUPITER AVE NE STE D
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8885
Mailing Address - Country:US
Mailing Address - Phone:586-709-8649
Mailing Address - Fax:
Practice Address - Street 1:6290 JUPITER AVE NE STE D
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8885
Practice Address - Country:US
Practice Address - Phone:616-538-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor