Provider Demographics
NPI:1841881232
Name:HARTMAN, TAYLOR RAE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 OLD DENTON RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-2318
Mailing Address - Country:US
Mailing Address - Phone:405-623-2212
Mailing Address - Fax:
Practice Address - Street 1:235 W HICKORY ST STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4138
Practice Address - Country:US
Practice Address - Phone:940-514-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor