Provider Demographics
NPI:1750435491
Name:HARTMAN, GREGORY RALPH (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RALPH
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 1:7270 COLLEGE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5658
Mailing Address - Country:US
Mailing Address - Phone:239-278-3344
Mailing Address - Fax:
Practice Address - Street 1:7270 COLLEGE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5658
Practice Address - Country:US
Practice Address - Phone:239-278-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3807126Medicaid
FL3807126Medicaid
FLU25437Medicare UPIN