MEDICARE: CHAD HARTLEY MD PLLCC

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	207T00000X	Neurological Surgery Physician	46672	CO

General Provider Information

NPI Number	:	1457623035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAD HARTLEY MD PLLCC

Provider Business Mailing Address
First Line	:	286 16TH ST
Second Line	:
City	:	BURLINGTON
State	:	CO
Zip	:	80807-1651
Country	:	US
Telephone Number	:	720-883-1593
Fax Number	:	720-335-6897

Provider Business Practice Location Address
First Line	:	1509 QUALL COURT
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80403-7770
Country	:	US
Telephone Number	:	720-883-1593
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHAD HARTLEY
Credential	:	MD
Telephone Number	:	720-883-1593

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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