Provider Demographics
NPI:1720108004
Name:HARTMANN, DAVID GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
Last Name:HARTMANN
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 1:5226 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3519
Mailing Address - Country:US
Mailing Address - Phone:314-842-6777
Mailing Address - Fax:314-842-0377
Practice Address - Street 1:5226 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3519
Practice Address - Country:US
Practice Address - Phone:314-842-6777
Practice Address - Fax:314-842-0377
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10851409OtherAETNA
3650OtherBLUE CROSS BLUE SHIELD
181680OtherHEALTHLINK
23597Medicare UPIN
32150Medicare ID - Type Unspecified