Provider Demographics
NPI:1457496648
Name:HARTMAN, ERIC JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:JAMES
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 700125
Mailing Address - Street 2:1205 WISCONSIN AVE
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-0125
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:53070-0125
Practice Address - Country:US
Practice Address - Phone:920-564-6672
Practice Address - Fax:920-564-6673
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3503012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38909000Medicaid
U72252Medicare UPIN
WI35341Medicare ID - Type Unspecified