MEDICARE: DR. ERIC RYAN HARTMAN 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	111N00000X	Chiropractor	2301008464	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	950G00526	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1346241742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC RYAN HARTMAN D. C.

Provider Business Mailing Address
First Line	:	302 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7909
Country	:	US
Telephone Number	:	616-457-1168
Fax Number	:	616-457-1196

Provider Business Practice Location Address
First Line	:	302 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7909
Country	:	US
Telephone Number	:	616-457-1168
Fax Number	:	616-457-1196

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	09/27/2013

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