MEDICARE: DR. MICHAEL ANTHONY HARTLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	08001622	IN
2	111NN1001X	Nutrition Chiropractor	2301007361	MI
3	111NN1001X	Nutrition Chiropractor	3042	WI
4	111NS0005X	Sports Physician Chiropractor	3164	MN

General Provider Information

NPI Number	:	1073610010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY HARTLE D.C.

Provider Business Mailing Address
First Line	:	1155 WESTOVER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-2561
Country	:	US
Telephone Number	:	260-456-8485
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6809
Country	:	US
Telephone Number	:	260-432-7339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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