MEDICARE: DR. LEE BRANDON 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	111NR0400X	Rehabilitation Chiropractor	12073	TX
2	111N00000X	Chiropractor	12073	TX

General Provider Information

NPI Number	:	1477808020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE BRANDON HARTMAN D.C.

Provider Business Mailing Address
First Line	:	6001 HARRIS PKWY
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-370-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 HARRIS PKWY
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-370-6350
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	05/08/2018

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